作者： 韦智经

单位：广州市荔湾区中医医院 外科，广东 广州 510160

Authors:  Wei Zhijing

Unit:  Department of Surgery, Liwan District Hospital of Traditional Chinese Medicine, Guangzhou 510160, Guangdong, China

摘要：

目的 探讨免疫增强型肠内营养对老年结肠癌患者腹腔镜术后炎症反应、肠黏膜屏障和免疫功能的影响。方法  回顾性分析2019年1月至2021年12月在广州市荔湾区中医医院接受腹腔镜手术切除肿瘤的80例老年结肠癌患者的临床资料，采用随机数字表法将患者分为实验组和对照组，每组各40例。对照组采用普通型肠内营养制剂干预，实验组则采用免疫增强型肠内营养制剂干预。采用HITACHI7060 全自动生化分析仪测定血清中白介素(interleukin, IL)-1、IL-6、IL-10、肿瘤坏死因子-α（tumor necrosis factor，TNF-α)、C反应蛋白（C-reactive protein，CRP）、血清白蛋白(albumin, ALB)、转铁蛋白(transferrin, TRF)、前白蛋白(prealbumin, PA)的表达；流式细胞仪检测血液循环中T淋巴细胞亚群CD4+ T细胞、CD8+ T细胞以及CD4+/CD8+的水平；酶联免疫吸附试验检测血清二胺氧化酶(diamine oxidase, DAO)和内毒素水平。比较上述各项指标在实验组和对照组中的差异以及两组患者不良反应和术后并发症的发生情况。结果  实验组和对照组患者的临床资料差异无统计学意义(P>0.05)。术后5 d实验组血清中IL-1、IL-6、IL-10、TNF-α、CRP的表达水平均低于同时间点的对照组(P<0.05)。术后5 d实验组血液循环中的CD4+ T细胞和CD4+/CD8+水平均高于同时间点的对照组，CD8+ T细胞水平则低于同时间点的对照组(P<0.05)。术后5 d，两组患者DAO和内毒素水平均低于入院后1 d (P<0.05)，且术后5 d实验组DAO和内毒素水平均低于同时间点的对照组(P<0.05)。术后5 d，两组患者的血清ALB、TRF 和PA 表达水平均高于入院后1 d (P<0.05)，且术后5 d实验组的血清ALB、TRF 和PA 表达水平均高于同时间点的对照组(P<0.05)。两组不良反应发生率、手术部位感染和吻合口瘘的发生率差异无统计学意义(P>0.05)。结论 免疫增强型肠内营养能够有效改善老年结肠癌患者腹腔镜术后肠黏膜屏障、免疫功能和营养状态，并缓解炎症反应。

关键词： 结肠癌；腹腔镜；免疫增强型肠内营养支持；肠黏膜屏障；免疫功能

Abstract：

Objective   To explore the effects of immune enhanced enteral nutrition on inflammatory response, intestinal mucosal barrier, and immune function for elderly colon cancer patients after laparoscopic surgery. Method  The clinical data of 80 elderly colon cancer patients who underwent laparoscopic resection of colon tumors in Liwan District Hospital of Traditional Chinese Medicine of Guangzhou from January 2019 to December 2021 were retrospectively analyzed. 80 patients were divided into experimental group and control group by random number table method, with 40 cases in each group. The control group was treated with normal enteral nutrition preparation. The experimental group was treated with immune enhanced enteral nutrition preparation. Expression levels of interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor-α(TNF-α), C-reactive protein (CRP), albumin (ALB), transferrin (TRF) and prealbumin (PA) in serum were determined by HITACHI 7060 automatic biochemical analyzer. The levels of T-lymphocyte subsets CD4+ T cells, CD8+ T cells and CD4+/CD8+ in the circulation were detected by flow cytometry. Enzyme linked immunosorbent assay was used to detect serum diamine oxidase (DAO) and endotoxin levels. The differences of the above indicators, the incidence of adverse reactions and postoperative complications between the experimental group and the control group were compared. Result  There were no statistically significant differences in the clinical information between the experimental group and the control group (P>0.05). The expression levels of IL-1, IL-6, IL-10, TNF-αand CRP in serum of the experimental group were lower than those of the control group at the same time point 5 days after surgery (P<0.05). The levels of CD4+ T cells and CD4+/CD8+ in blood circulation of the experimental group were higher than those of the control group at the same time point 5 days after surgery, while the level of CD8+ T cells was lower than that of the control group at the same time point(P<0.05). On day 5 after surgery, the levels of DAO and endotoxin in two groups were lower than day 1 after admission (P<0.05). Moreover, the levels of DAO and endotoxin of the experimental group were lower than those of the control group at the same time point 5 days after surgery (P<0.05). The expression levels of serum ALB, TRF and PA in two groups on day 5 after surgery were higher than day 1 after admission (P<0.05). The expression levels of serum ALB, TRF and PA in the experimental group were higher than those in the control group at the same time point 5 days after surgery (P<0.05). There were no statistically significant differences in the incidence of adverse reactions, surgical site infection and anastomotic fistula between the two groups (P>0.05). Conclusion  Immune enhanced enteral nutrition can effectively improve the intestinal mucosal barrier, immune function and nutritional status for elderly colon cancer patients after laparoscopic surgery, and alleviate inflammatory reactions.

Key Words:  Colon cancer; Laparoscope; Immune enhanced enteral nutrition support; Intestinal mucosal barrier; Immune function

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