Shoji Fumihiro, Kozuma Yuka, Toyokawa Gouji, Yamazaki Koji, Takeo Sadanori
Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
JMA J. 2021 Oct 15;4(4):387-396. doi: 10.31662/jmaj.2021-0095. Epub 2021 Sep 21.
Several immunonutritional supplements have recently been developed. However, improvements in preoperative immunonutritional conditions using these supplements have not been analyzed in patients undergoing thoracic surgery.
This prospective, single-arm, single-institution pilot study involved patients planning to undergo thoracic surgery. Forty adults with a poor preoperative immunonutritional status were enrolled. The patients freely selected one of three oral immunonutritional supplements (IMPACT, MEIN, or Abound) and started taking it on an outpatient basis from 7 to 14 days before thoracic surgery. The primary endpoint was the rate of improvement in three immunonutritional parameters on the hospitalization day: body mass index (BMI), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI). These improvement rates were compared with those of a matched historical control group.
The PNI and GNRI improvement rates were significantly higher in the immunonutritional support group than in the control group (PNI: 103.1% ± 0.6% vs. 98.9% ± 1.3%, p = 0.0391; GNRI: 101.7% ± 0.8% vs. 99.3% ± 0.8%, p = 0.0266), although there was no significant difference in the BMI improvement rate (101.0% ± 0.6% vs. 100.2% ± 0.7%, p = 0.3626). The PNI and GNRI improvement rates were significantly higher in the IMPACT support group than in the control group (PNI: 104.5% ± 2.4% vs. 98.9% ± 1.3%, p = 0.0212; GNRI: 101.6% ± 1.1% vs. 99.3% ± 0.8%, p = 0.0415).
The present study revealed that short-term preoperative immunonutritional support can actually improve immunonutritional parameters immediately before surgery. In particular, preoperative immunonutritional support using IMPACT supplementation might be the most promising agent in patients with a poor immunonutritional condition undergoing elective thoracic surgery.
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近年来已研发出多种免疫营养补充剂。然而，尚未对接受胸外科手术患者使用这些补充剂改善术前免疫营养状况的情况进行分析。
这项前瞻性、单臂、单机构的试点研究纳入了计划接受胸外科手术的患者。招募了40名术前免疫营养状况较差的成年人。患者自由选择三种口服免疫营养补充剂（IMPACT、MEIN或Abound）之一，并在胸外科手术前7至14天开始在门诊服用。主要终点是住院当天三个免疫营养参数的改善率：体重指数（BMI）、预后营养指数（PNI）和老年营养风险指数（GNRI）。将这些改善率与匹配的历史对照组进行比较。
免疫营养支持组的PNI和GNRI改善率显著高于对照组（PNI：103.1%±0.6%对98.9%±1.3%，p = 0.0391；GNRI：101.7%±0.8%对99.3%±0.8%，p = 0.0266），尽管BMI改善率无显著差异（101.0%±0.6%对100.2%±0.7%，p = 0.3626）。IMPACT支持组的PNI和GNRI改善率显著高于对照组（PNI：104.5%±2.4%对98.9%±1.3%，p = 0.0212；GNRI：101.6%±1.1%对99.3%±0.8%，p = 0.0415）。
本研究表明，术前短期免疫营养支持实际上可在手术前即刻改善免疫营养参数。特别是，对于接受择期胸外科手术且免疫营养状况较差的患者，使用IMPACT补充剂进行术前免疫营养支持可能是最有前景的方法。
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