Lin M T, Saito H, Fukushima R, Inaba T, Fukatsu K, Inoue T, Furukawa S, Han I, Matsuda T, Muto T
Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Nutrition. 1997 Jan;13(1):8-12. doi: 10.1016/s0899-9007(97)90871-6.
Previous human studies have investigated the influences of nutritional routes on the serum kinetics of cytokines following intravenous administration of lipopolysaccharide. However, it is unclear whether preoperative nutritional routes influence responses of systemic cytokines in patients after surgery. This study was designed to investigate whether preoperative total parental nutrition (TPN) influences systemic interleukin-6 (IL-6) and interleukin-8 (IL-8) responses in patients following surgery for colorectal cancer. Patients with colorectal cancer received TPN (TPN group, n = 6) or an oral diet (oral group n = 6) for more than 7 d before the operation. Patients in the TPN group received standard TPN. Patients in the oral group received an ordinary hospital diet. Blood samples were collected before the operation, on postoperative day 1 (POD1), POD3, and POD7. Levels of IL-6, IL-8, and C-reactive protein (CRP) in plasma were determined. The characteristics of patients in the TPN and oral groups were comparable. Mean carbohydrate intake was greater (28 versus 19 kCal/kg), and lipid intake was smaller (0 versus 7 kCal/kg) in the TPN group than in the oral group. Plasma CRP levels did not differ between the two groups. Plasma IL-6 and IL-8 levels were marginally higher before the operation and were significantly higher on POD1 in the TPN group than in the oral group. The IL-6 levels showed a positive regression relation with the amounts of blood loss only in the TPN group (P < 0.05, r = 0.881). The slope of the regression line was steeper in the TPN group than in the total enteral nutrition (TEN) group (P < 0.01). In conclusion, routes of nutritional supply have an impact on the production of systemic cytokines after insult. The postoperative systemic IL-6 and IL-8 responses in patients who received standard TPN preoperatively were greater than in patients who received an oral diet. Preoperative nutrition via the enteral route may provide better regulation of cytokine responses after surgery than parenteral nutrition.
以往的人体研究调查了营养途径对静脉注射脂多糖后细胞因子血清动力学的影响。然而，术前营养途径是否会影响术后患者全身细胞因子的反应尚不清楚。本研究旨在调查术前全肠外营养（TPN）是否会影响结直肠癌手术后患者全身白细胞介素-6（IL-6）和白细胞介素-8（IL-8）的反应。结直肠癌患者在手术前接受超过7天的TPN（TPN组，n = 6）或口服饮食（口服组，n = 6）。TPN组患者接受标准TPN。口服组患者接受普通医院饮食。在手术前、术后第1天（POD1）、POD3和POD7采集血样。测定血浆中IL-6、IL-8和C反应蛋白（CRP）的水平。TPN组和口服组患者的特征具有可比性。TPN组的平均碳水化合物摄入量更高（28对19千卡/千克），脂质摄入量更低（0对7千卡/千克）。两组间血浆CRP水平无差异。TPN组术前血浆IL-6和IL-8水平略高，且在POD1时显著高于口服组。仅在TPN组中，IL-6水平与失血量呈正相关（P < 0.05，r = 0.881）。TPN组回归线的斜率比全肠内营养（TEN）组更陡（P < 0.01）。总之，营养供应途径对损伤后全身细胞因子的产生有影响。术前接受标准TPN的患者术后全身IL-6和IL-8反应大于接受口服饮食的患者。术前通过肠内途径营养可能比肠外营养能更好地调节术后细胞因子反应。
