[1]陈德利,葛思堂,左芦根,等.胃癌术后早期肠内营养对术后炎症反应及肠屏障功能的影响[J].肠外与肠内营养杂志,2020,(04):222-225229.[doi:10.16151/j.1007-810x.2020.04.007]
 CHEN De-li,GE Si-tang,ZUO Lu-gen,et al.Effects of early enteral nutrition on postoperative inflammation and intestinal barrier function in patients with gastric cancer[J].PARENTERAL & ENTERAL NUTRITION,2020,(04):222-225229.[doi:10.16151/j.1007-810x.2020.04.007]
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胃癌术后早期肠内营养对术后炎症反应及肠屏障功能的影响
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2020年04期
页码:
222-225229
栏目:
论著
出版日期:
2020-07-10

文章信息/Info

Title:
Effects of early enteral nutrition on postoperative inflammation and intestinal barrier function in patients with gastric cancer
作者:
陈德利葛思堂左芦根朱平胜李仕青刘牧林
蚌埠医学院第一附属医院胃肠外科,安徽蚌埠 233004
Author(s):
CHEN De-li GE Si-tang ZUO Lu-gen ZHU Ping-sheng LI Shi-qing LIU Mu-lin
Department of Gastrointestinal Surgery, the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004, Anhui, China
关键词:
肠内营养支持治疗 术后康复 胃癌 炎症反应 肠屏障功能
Keywords:
Enteral nutrition Postoperative rehabilitation Gastric cancer Inflammatory response Intestinal barrier function
分类号:
R459.3,R45
DOI:
10.16151/j.1007-810x.2020.04.007
文献标志码:
A
摘要:
目的:观察不同营养支持治疗对病人术后炎症反应和肠屏障功能的影响,以期为胃癌术后营养支持治疗提供参考。 方法:纳入2017年1月至2019年12月接受胃癌根治术的病人,依据病人术后营养支持治疗方式不同分为观察组(术后早期肠内营养)和对照组(全胃肠外营养)。比较两组术后康复情况,分析两组术后3 d外周血炎症介质及肠屏障功能指标,并进一步分析炎症指标与肠屏障指标间的相关性。 结果:共纳入观察组病人46例,对照组43例。观察组病人术后首次排气时间(t = 2.015,P = 0.047)、恢复经口饮食时间(t = 2.692,P = 0.009)和术后住院日(t = 2.934,P = 0.004)均显著短于对照组。观察组病人术后全身炎症反应综合征发生率显著低于对照组病人[(13.04%,6/46) vs (32.56%,14/43),χ2 = 4.858,P = 0.028)]。观察组病人术后 3 dC-反应蛋白(t = 4.978,P <0.01)、白介素6(t = 4.070,P < 0.01)及肿瘤坏死因子α(t = 8.795,P < 0.01)、血D-乳酸(t = 5.267,P < 0.01)和肠脂肪酸结合蛋白(t = 6.373,P < 0.01)水平均显著低于对照组。病人术后3 d外周血IL-6与D-乳酸(r = 0.825,P < 0.01)和IFABP(r = 0.766,P < 0.01)均呈现显著正相关关系。 结论:术后早期肠内营养支持治疗可加速胃癌病人术后康复,保护术后肠屏障功能并抑制系统性炎症反应程度。
Abstract:
Objective: To observe the effects of different nutrition therapy on postoperative inflammatory responses and intestinal barrier function of gastric cancer patients as well as to provide a reference for nutrition therapy of gastric cancer after surgery. Methods: The patients who underwent radical gastrectomy for gastric cancer from January 2017 to December 2019 were enrolled and divided into either observation group (receiving early postoperative enteral nutrition) or control group (receiving total parenteral nutrition). The postoperative rehabilitation status of the two groups was compared, the peripheral blood inflammatory mediators and intestinal barrier function indexes at 3 days postoperatively were analyzed, and the correlation between inflammation indexes and intestinal barrier indexes was further analyzed. Results: A total of 46 patients in the observation group and 43 in the control group were included. There were significantly shorter time of first anal exhaust (t = 2.015,P = 0.047), resume oral diet (t = 2.692,P = 0.009) and length of postoperative hospital stay (t = 2.934,P = 0.004) in patients of the observation group when compared with those of the control group. The incidence of systemic inflammatory response syndrome in the observation group was significantly lower than that in the control group [(13.04%, 6/46) vs (32.56%, 14/43), χ2 = 4.858,P = 0.028)]. The levels of C-reactive protein (t = 4.978,P < 0.01), interleukin 6 (t = 4.070,P < 0.01), tumor necrosis factor alpha (t = 8.795,P <0.01) , D-lactic acid (t = 5.267,P < 0.01), and intestinal fatty acid binding protein (t = 6.373,P < 0.01) were significantly lower in the observation group than those of the control group. There was a significantly positive correlation between IL-6 and D-lactic acid (r = 0.825,P < 0.01), and IFABP (r = 0.766,P < 0.01) at 3 days after operation. Conclusion: Early postoperative enteral nutrition could accelerate recovery of gastric cancer patients, protect the intestinal barrier function and inhibit the degree of systemic inflammatory response.

参考文献/References:


[1] 白慧霞. 中国胃癌发病率及死亡率研究进展. 临床医药文献电子杂志, 2019, 6(7):192.
[2] 韩 川, 吴 琼, 倪 阵, 等 . 1989~2014 年中国胃癌发病率与统计年鉴指标的相关性分析 . 肿瘤预防与治疗, 2019,32(5):434-440.
[3] Wang J, Li Y, Qi Y. Effect of glutamine-enriched nutritional support on intestinal mucosal barrier function, MMP-2, MMP-9 and immune function in patients with advanced gastric cancer during perioperative chemotherapy. Oncol Lett, 2017,14(3):3606-3610.
[4] 谢荣臻, 曾祥福, 邓 伟, 等. 术后早期肠内营养在胃癌病人治疗中的临床观察. 肠外与肠内营养, 2017,24(4):225-228.
[5] 王姗, 葛思堂, 周 英, 等. 序贯性早期肠内营养在胃癌病人术后康复治疗中的应用效果 . 肠外与肠内营养, 2018, 25(2):102-106.
[6] 高良荣, 孔令环, 周丽梅. 管道护理在胃癌术后吻合口瘘病人中的应用体会. 肠外与肠内营养, 2020,27(01):61-64.
[7] Abolaji AO, Fasae KD, Iwezor CE, et al. Curcumin attenuates copper-induced oxidative stress and neurotoxicity in Drosophila melanogaster. Toxicol Rep, 2020,7:261-268.
[8] Roh CK, Son SY, Lee SY, et al. Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single center phase II clinical trial for safety and efficacy. J Surg Oncol,2020,121(4):662-669.
[9] 黎介寿 . 营养支持治疗与加速康复外科 . 肠外与肠内营养,2015,22(2):65-67.
[10] Gemmill EH, Humes DJ, Catton JA. Systematic review of enhanced recovery after gastro-oesophageal cancer surgery. Ann R Coll Surg Engl, 2015,97(3):173-179.
[11] Kurokawa Y, Yamashita K, Kawabata R, et al. Prognostic value of postoperative C-reactive protein elevation versus complication occurrence: a multicenter validation study. Gastric Cancer, 2020.
[12] Wang N, Lu K, Qu H, et al. CircRBM33 regulates IL-6 to promote gastric cancer progression through targeting miR-149. Biomed Pharmacother, 2020,125:109876.
[13] Wang Y, Zhou M, Shang D. Berberine inhibits human gastric cancer cell growth via deactivation of p38/JNK pathway, induction of mitochondrial-mediated apoptosis, caspase activation and NF-κB inhibition. J BUON, 2020, 25(1):314-318.
[14] Zhou Q, Wu X, Wang X, et al. The reciprocal interaction between tumor cells and activated fibroblasts mediated by TNF- α/IL-33/ST2L signaling promotes gastric cancer metastasis. Oncogene,2020, 39(7):1414-1428.
[15] Eskiler GG, Bezdegumeli E, Ozman Z, et al. IL-6 mediated JAK/STAT3 signaling pathway in cancer patients with cachexia.Bratisl Lek Listy, 2019,66(11):819-826.
[16] Zhang Y, Cong X, Li Z, et al. Estrogen facilitates gastric cancer cell proliferation and invasion through promoting the secretion of interleukin-6 by cancer-associated fibroblasts. Int Immunopharmacol, 2020,78:105937.
[17] Jafari-Nedooshan J, Dastgheib SA, Kargar S, et al. Association of IL-6 -174 G>C Polymorphism with Susceptibility to Colorectal Cancer and Gastric Cancer: a Systematic Review and Meta Analysis. Acta Medica (Hradec Kralove), 2019,62(4):137-146.
[18] Dohle DS, Bestendonk C, Petrat F, et al. Serum markers for early detection of patients with mesenteric ischemia after cardiac surgery. Innov Surg Sci, 2018,3(4):277-283.
[19] Cheng Y, Zhang J, Zhang L, et al. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis. BMC Gastroenterol, 2018,18(1):11.
[20] Yu QS, Zheng Z, Peng H, et al. Effect of Qihuang Decoction Combined with Enteral Nutrition on Postoperative Gastric Cancer of Nutrition and Immune Function. Evid Based Complement Alternat Med, 2020:1795107.

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备注/Memo

备注/Memo:
基金项目 :国家自然科学基金(81700476);安徽省自然科学基金(1808085QH237);蚌埠医学院杰出青年基金(2019byyfyjq01) 作者简介 :陈德利,副主任医师,医学硕士,从事消化系统肿瘤和临床营养治疗研究。E-mail:chendeli66@163.com 通讯作者 :刘牧林,E-mail:liumulin66@aliyun.com
更新日期/Last Update: 1900-01-01