Wang Daguang, Zhang Hua, Zhang Yang, Li Wei, Sun Xuan, Xing Yanpeng, Suo Jian
Department of Gastrointestinal Surgery, The First Affilated Hospital of Jilin University, Changchun 130021, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2015 Jul;18(7):651-5.
To investigate the effect of omega-3 polyunsaturated fatty acids (PUFA) on postoperative inflammatory response and clinical efficacy in gastric cancer patients with nutritional risk.
All patients with gastric cancer in our department from June 2013 to January 2014 undergoing radical gastrectomy were prospectively enrolled in the study. Patients who matched the selection criteria were randomly divided into two groups: trial group (with omega-3 PUFA in parenteral nutrition) and control group (without omega-3 PUFA in parenteral nutrition). Levels of inflammatory factors (serum CRP, TNF-α, IL-1, IL-6, IL-10) and nutrition-related proteins (prealbumin, retinol conjugated protein and transferrin) were compared between the two groups before operation and 2, 4 and 6 days after operation. Incidence of postoperative systemic inflammatory response syndrome (SIRS) and other indicators associated with efficacy were compared between the two groups as well.
Forty-seven patients were finally included in this study with 21 patients in the trial group and other 26 in the control group. There were no significant differences of inflammatory factors and nutrition-related proteins between the two groups before operation (all P>0.05). In the 6th days after operation, the levels of proinflammatory cytokines, including CRP, IL-1 and IL-6 were significantly lower in the trial group as compared to the control group, while the level of IL-10 (inhibiting inflammatory cytokine) was higher in the trial group, as well as levels of nutrition proteins(all P<0.05). The trial group had significantly lower rate of SIRS than the control group [57.1%(12/21) vs. 84.6% (22/26), P=0.036]. Compared with the control group, patients in the trial group had shorter bowel sound recovery time [(12.3±1.1) d vs. (3.1±1.3) d, P=0.025], earlier passage of flatus [(3.1±1.0) d vs. (3.9±1.2) d, P=0.025] and shorter hospital stay [(9.4±2.1) d vs. (10.9±2.5) d, P=0.038], but there was no difference in postoperative complication rate between the two groups (P=0.678).
Omega-3 PUFA can reduce the release of inflammatory promoters, promote the release of inhibiting inflammatory cytokine IL-10, decrease the incidence of SIRS, improve patients' nutritional state, expedite the recovery of gastrointestinal function and shorten patients' recovery time.
探讨ω-3多不饱和脂肪酸（PUFA）对有营养风险的胃癌患者术后炎症反应及临床疗效的影响。
前瞻性纳入2013年6月至2014年1月在我科行根治性胃切除术的所有胃癌患者。符合入选标准的患者随机分为两组：试验组（肠外营养中含ω-3 PUFA）和对照组（肠外营养中不含ω-3 PUFA）。比较两组患者术前及术后2、4、6天炎症因子（血清CRP、TNF-α、IL-1、IL-6、IL-10）水平及营养相关蛋白（前白蛋白、视黄醇结合蛋白和转铁蛋白）水平。比较两组患者术后全身炎症反应综合征（SIRS）的发生率及其他疗效相关指标。
本研究最终纳入47例患者，试验组21例，对照组26例。两组患者术前炎症因子及营养相关蛋白水平比较，差异均无统计学意义（均P>0.05）。术后第6天，试验组CRP、IL-1和IL-6等促炎细胞因子水平明显低于对照组，而试验组IL-10（抗炎细胞因子）水平较高，营养蛋白水平也较高（均P<0.05）。试验组SIRS发生率明显低于对照组[57.1%（12/21）比84.6%（22/26），P=0.036]。试验组患者肠鸣音恢复时间[（12.3±1.1）天比（3.1±1.3）天，P=0.025]、首次排气时间[（3.1±1.0）天比（3.9±1.2）天，P=0.025]及住院时间[（9.4±2.1）天比（10.9±2.5）天，P=0.038]均短于对照组，但两组术后并发症发生率比较，差异无统计学意义（P=0.678）。
ω-3 PUFA可减少促炎介质的释放，促进抗炎细胞因子IL-10的释放，降低SIRS的发生率，改善患者营养状况，加快胃肠功能恢复，缩短患者康复时间。
