目的:探讨老年食管癌患者术后早期肠内营养支持对抗肿瘤免疫应答、炎症反应进程的影响。方法:选择在本院接受根治性手术治疗的110例老年食管癌患者,根据术后营养干预方式将其分为接受肠外营养支持的肠外营养组57例、接受肠内营养支持的肠内营养组53例。对比两组患者回到病房后即刻(T0)、营养支持后48 h(T1)、营养支持后72 h(T2)抗肿瘤免疫应答及炎症反应程度的差异。结果:T0时,两组Th1/Th2免疫应答、Th17/Treg免疫应答指标及血清炎症介质含量的差异无统计学意义。T1、T2时,肠内营养组血清中Th1细胞因子IFN-γ、IL-12的含量高于肠外营养组,Th2细胞因子IL-4、IL-13的含量低于肠外营养组；血清中Th17细胞因子IL-6、IL-17及Treg细胞因子TGF-β、IL-10的含量低于肠外营养组；血清中炎症介质hs-CRP、PGE、HMGB1的含量低于肠外营养组。结论:老年食管癌患者术后早期肠内营养支持可有效调节机体Th1/Th2、Th17/Treg免疫应答平衡,并抑制全身炎症反应。
Objective: To explore the effect of postoperative early enteral nutrition support on anti-tumor immune response and inflammatory response process in the elderly patients with esophageal cancer. Methods: At total of 110 elderly patients with esophageal cancer who underwent radical operation in this hospital between January 2015 and December 2017 were divided into the parenteral nutrition group (n=57) who received parenteral nutrition support and the enteral nutrition group (n=53) who received enteral nutrition support according to the postoperative nutrition intervention methods. The differences in anti-tumor immune response and inflammatory response degree were compared between the two groups of patients immediately after the patients returned to the ward (T0), 48 h after nutritional support (T1) and 72 h after nutritional support (T2). Results:At T0, there was no statistically significant difference in the contents of Th1/Th2 immune response and Th17/Treg immune response indexes as well as inflammatory mediators in serum between the two groups of patients. At T1 and T2, serum Th1 cytokines IFN-γ and IL-12 contents of enteral nutrition group were higher than those of parenteral nutrition group whereas Th2 cytokines IL-4 and IL-13 contents were lower than those of parenteral nutrition group; serum contents of Th17 cytokines IL-6 and IL-17 as well as Treg cytokines TGF-β and IL-10 were lower than those of parenteral nutrition group; serum inflammatory mediators hs-CRP, PGE and HMGB1 contents were lower than those of parenteral nutrition group. Conclusion: Postoperative early enteral nutrition support can effectively regulate the Th1/Th2 and Th17/Treg immune response balance and inhibit the systemic inflammatory response in elderly patients with esophageal cancer.