胃癌患者术前补充谷氨酰胺对血小板吞噬活性和术后早期结局的影响。
Preoperative Glutamine Supplementation in Gastric Cancer-Thrombocyte Phagocytic Activity and Early Postoperative Outcomes.
机构信息
Second Department of General and Gastroenterological Surgery, Medical University of Bialystok, M. Sklodowskiej-Curie Street 24a, 15-276 Bialystok, Poland.
Department of Clinical Laboratory Diagnostics, Medical University of Białystok, 15-269 Białystok, Poland.
出版信息
Nutrients. 2023 Jun 27;15(13):2911. doi: 10.3390/nu15132911.
BACKGROUND
The aim of this study was to determine the phagocytic activity of thrombocytes in patients with gastric cancer and to assess the effect of oral and parenteral preoperative glutamine-based immunonutrition on nutritional status, thrombocyte phagocytic activity, and early postoperative outcomes.
METHODS
Patients suffering from invasive gastric cancer had been treated with preoperative immunonutrition with glutamine, and they were compared to patients without nutritional treatment. Nutritional status, percentage of weight loss, and BMI were assessed. Levels of total protein, albumin, cholesterol, triglycerides, platelets, and their phagocytic ability were measured twice. Postsurgical complications were assessed via the Clavien-Dindo classification.
RESULTS
Group I consisted of 20 patients with an oral glutamine-10 g daily. Group II had 38 patients who received intravenous glutamine, 1.5 mL per kg body weight of Dipeptiven. Group III consisted of 25 patients who did not receive preoperative immunonutrition. In total, 47% of patients in Group I, 54% of patients in Group II, and 33% of patients in Group III were malnourished. In Group I, the percentage of phagocytizing platelet (%PhP) was 1.1 preoperatively and 1.2 postoperatively. The phagocytic index (PhI) was 1.0 and 1.1. In Group II, %PhP was 1.1 and 1.2 and PhI was 1.0 and 1.1. In Group III, the %PhP was 1.0 and 1.2 and PhI was 1.0 and 1.1. An increase in triglyceride level was observed in both immunonutrition groups. There was a decline in total protein and albumin level in Group II. In Group III, there was a decline in total protein, albumin, and cholesterol level. The total platelet count and PhI were increased in both immunonutrition groups. There was also a rise in %PhP in Group II. In Group III, there was a rise in blood platelet level, %PhP, and PhI. The complication rates were 53% in Group I, 29% in Group II, and 40% in Group III.
CONCLUSIONS
In invasive gastric cancer, laboratory nutritional parameters are significantly reduced, causing malnutrition in 44.7% of patients. Oral glutamine supplementation inhibited the postoperative decline in protein metabolism parameters; however, this did not affect the reduction in the percentage of postoperative complications. Glutamine used preoperatively significantly reduced the percentage of serious surgical complications, regardless of the way it was supplemented. Patients with invasive gastric cancer have a significant decrease in platelet phagocytic activity. The administered preoperative parenteral nutrition and the surgical procedure itself influenced the improvement of the phagocytic activity of blood platelets. Glutamine did not have this effect, regardless of the route of administration.
背景
本研究旨在确定胃癌患者血小板的吞噬活性，并评估口服和肠外术前谷氨酰胺为基础的免疫营养对营养状况、血小板吞噬活性和术后早期结果的影响。
方法
接受术前免疫营养治疗的侵袭性胃癌患者接受了谷氨酰胺治疗，并与未接受营养治疗的患者进行了比较。评估了营养状况、体重减轻百分比和 BMI。两次测量了总蛋白、白蛋白、胆固醇、甘油三酯、血小板及其吞噬能力。通过 Clavien-Dindo 分类评估术后并发症。
结果
I 组包括 20 名每天口服 10 克谷氨酰胺的患者。II 组有 38 名患者接受静脉注射谷氨酰胺，1.5 毫升/公斤体重 Dipeptiven。III 组包括 25 名未接受术前免疫营养的患者。I 组、II 组和 III 组分别有 47%、54%和 33%的患者营养不良。在 I 组中，血小板吞噬率（%PhP）术前为 1.1%，术后为 1.2%。吞噬指数（PhI）为 1.0 和 1.1。在 II 组中，%PhP 为 1.1%和 1.2%，PhI 为 1.0%和 1.1%。在 III 组中，%PhP 为 1.0%和 1.2%，PhI 为 1.0%和 1.1%。两个免疫营养组的甘油三酯水平均升高。II 组总蛋白和白蛋白水平下降。III 组总蛋白、白蛋白和胆固醇水平下降。两个免疫营养组的血小板总数和 PhI 均增加。II 组的%PhP 也有所上升。III 组的血小板水平、%PhP 和 PhI 均升高。I 组的并发症发生率为 53%，II 组为 29%，III 组为 40%。
结论
在侵袭性胃癌中，实验室营养参数显著降低，导致 44.7%的患者发生营养不良。口服谷氨酰胺补充抑制了术后蛋白质代谢参数的下降；然而，这并没有影响术后并发症减少的情况。术前使用谷氨酰胺显著降低了严重手术并发症的百分比，无论补充方式如何。侵袭性胃癌患者血小板吞噬活性显著下降。给予的术前肠外营养和手术本身影响了血小板吞噬活性的改善。谷氨酰胺没有这种作用，无论给药途径如何。
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