Objective To evaluate the effectiveness and safety of lentinan on immune function in patients with advanced gastric cancer. Methods We searched MEDLINE (1969-2006), EMBASE (1984-2006), OVID (1969-2006), CENTRAL (Cochrane Central Register of Controlled Trials in The Cochrane Library) (Issue 4, 2006), the Chinese Biomedicine Database (1978-2006) and CNKI (1978-2006). We also handsearched relevant journals. Pharmaceutical companies were contacted to identify additional randomized controlled trials. We assessed the identified studies in order to include high quality studies. Results Ten studies (containing 786 patients) met the inclusion criteria. Six trials shown that lentinan+FAM had significant efficacy upon patients with advanced gastric cancer compared with FAM in overall response [Plt;0.01, RR1.70, 95%CI (1.39,2.09)]. In three trials, a significant effect of lentinan+FAM group compared with FAM group in quantity of CD3+ T, T4/T8, NK was found, but lower than FAM group in side- effect of digestive system [RR0.71, 95%CI (0.55,0.91)]. The other trail identified there were fewer side effects in lentinan+FAM group compared with FAM group, though did not discribe the overall response. In case the significant heterogeneity, meta-analysis could not be used for the other three trails included, since the components of chemotherapeutic agents (ATP+Co-A+Vc; DDP+ Epirubicin+5FU; 5FU+CF+VP16) were not the same. In the three trials, overall response was statistically significant better in the lentinan group than in the control group, and lentinan group could significantly increase the quantity of CD3+ T, T4/T8, NK compared with control group. Conclusions The present meta-analysis suggested that addition of lentinan to standard chemotherapy provided a significant advantage over chemotherapy alone in terms of efficacy for patients with advanced gastric cancer. However, most of trials included in the review were of low quality, therefore, it is of necessity to conduct multi-center randomized-controlled trials of high quality.
Objective To explore the effect of different nutrition on the immune function of patients with colorectal cancer. Methods A total of 640 colorectal cancer patients were randomized into the enteral nutrition and peripheral nutrition groups. The peripheral venous blood was sampled before operation and on the postoperative days 1 and 7 to determine the serum levels of IgG, IgA, IgM, the percentage of T lymph cell subgroups CD3, CD4, CD4/CD8 and CRP, PGE, α- antitrypsin etc. The patient’s general condition, side-effects, and complications were observed intimately after surgery. Results Compared with the control group, the IgG, IgA, IgM, CD3, CD4,CD4/CD8 levels of the trial group on postoperative day 7 were higher. But the levels of CRP, PGE, α- antitrypsin were decreased. Hospitalization time and anal exsufflation time were shorter as well. There was no significant difference in either the general conditions or complications between the two groups. Conclusion Application of enteral nutrition after colorectal cancer surgery is safe, ,effective, and can improve the patient’s immune function and prognosis.
肿瘤患者常常具有不适应情绪和行为反应,如焦虑、抑郁、悲伤、愤怒、恐惧等。针对这类患者的特征,我们对肿瘤科查房模式进行探讨,旨在缓解患者的不良情绪,提高肿瘤患者的治疗疗效,降低医疗风险。
To study the effects of arginine supplementation in total parenteral nutrition (TPN) on lymphocytic immune function in postoperative patients with gastric cancer. Thirty six patients with gastric cancer receiving TPN were eligible for entry into randomized and prospective clinical trial of the study. T cell subsets, NK cell activity, plasma IL-2 content and peripheral blood CD25 were measured in before and after parenteral nutrition of the patients. Results: usual TPN could not improve lymphocytic immunosuppression of postoperative patients with gastric cancer. The patients receiving arginine supplementation in TPN might enhance lymphocytic immune function by increasing CD4 level, IL-2 production and NK cell activity, but there was no significant effect of arginine on CD25 expression. Conclusion: there are some effects of supplement with arginine on releasing of the cellular immunosuppression and restoring of lymphocytic immune function.
In order to study the immune function of patients with obstructive jaundice, the rate of RBC-C3b receptor rosette (RCR), tumour-RBC rosettes (TRR), RBC-immune complex rosette (RICR) and CD３+,CD4+,CD8+ cells were investigated. In these patients, the pre-operative erythrocyte and T lymphocyte subsets immune functions were lower than those of the control (Ｐ＜0.001). At the 5th day after operation, there was no significant change and 14th day after operation the erythrocyte and T lymphocyte substes immune functions were significantly elevated(Ｐ＜0.05), while, compared with the normals, which was still depressed in some degree. Operation is useful to the recovery of the immune function in all patients.
To study the effects of human growth hormone on protein catabolic state of gastric and colonic cancer patients after surgical intervention and whether it can improve the postoperative host immune function and reduce the postoperative fatigue syndrome (POF) by using rhGH. Thirtyeight gastric and colonic cancer patients (21 cases of gastric cancer; 17 cases of colonic cancer) were diveided into control group (n＝18) and rhGHtreated group (n＝20). All the patients were performed resection and treated by early postoperative intraperitoneal thermochemotherapy (EPIC) and total parenteral nutrition (TPN). Subcutaneous injections of 8 U rhGH at 9∶30 am was administered to the rhGHtreated group (six days) at the same time. Results: In the control group, a significant decrease in serum levels of albumin, prealbumin, transferri, IgG, IgA, IgM and CD＋３, CD＋4, CD＋8 were observed after operation (Ｐ＜0.01). In the rhGHtreated group, CD＋３, CD＋4 and CD＋8 raised significantly and the other did not change significantly. The postoperative vigour state of the patient was better than that in the control group. In the control group, pronouced weight loss of 3-5 kg, was detected on the 10th pastoperative day, while the weight loss was 1-2 kg in the rhGHtreated group (Ｐ＜0.01). Conclusion: The treatment with rhGH together with TPN and EPIC not only overcomes the protein catabolism of the cancer patient after operation by increasing protein synthesis, but also improves postoperative host immune function, reduces POF, and can raise the killing effect of chemotherapy on cancer cells, enhances the tolerance to chemotherapy.
In order to investigate pre-and postoperative changes of prostagladin E2 (PGE2) and cellular immune function in patients with gastric cancer (GC), we measured T cell subsets, natural killer cell activity (NKCA) and PGE2 in peripheral blood (PB) of 31 GC patients and 30 controls with APAAP method, LDH release method and radioimmunoassay respectively. The results showed：① a significantly higher levels of PGE2, and a markedly lower levels of CD+4/CD+8 ratio in GC patients before surgery as compared with the controls. The PGE2 had a significant negtive coorelation with CD+4/CD+8 ratio and NKCA respectively.②PGE2 in PB of GC patients gradully declined to normal levels after surgery, moreover PGE2 in tumor tissue was markedly higher than that in normal tissue, implying that the tumor may be the major source of PGE2 in PB. Dynamic determination of PGE2 in PB would be great valuable in evaluation of cellular immune state, to evaluate the effect of surgery and prognosis of patients with gastric cancer.
Cimetidine was given intravenously in daily dose of 20mg/kg to 20 patients with malignant tumor from the operative day on. The results show that cimetidine can elevate CD4, CD4/CD8 and decrease CD8. For comparison, blood samples from 40 patients were taken before operation for extracorporal testing. The results show that cimetidine can elevate lymphocyte transformation test and interleukin-2 secretive cell. These indicate that cimetidine can enhance the immune function of the patient and can be used as an adjunctive treatment of neoplasm.
Objective To explore the pathogens and clinical features of immunocompromised hosts with septicaemia.Methods The data including underlying diseases, peripheral blood granulocyte count, temperature at blood sampling, management and prognosis)of 160 immunocompromised hosts with septicaemia were analyzed retrospectively．Results 8 patients had twice septicaemia in hospital stay and 3 patients had plural pathogenic septicaemia.171 strains of microorganisms were isolated from blood cultured of 160 septic immuno- compromised hosts in which 156 strains (91.2%) were bacteria, 37 strains(21.6%) were gram positive cocci, 6 strains(3.5%) were gram positive bacilli, 113 strains (66.1%) were gram negative bacilli and 15 strains (8.8%) were fungi. Staphylococcus spp (17 strains) and Streptococcus spp (14 strains) were the predominant pathogens among gram positive cocci and Corynebacteria (5 strains ) were the main pathogen in gram positive bacilli while Escherichia coli (60 strains), Klebsiella pneumoniae (20 strains) and Pseudomonas aeruginosa (15 strains) were the most common bacteria in gram negative bacilli. There were 12 strains of Staphylococcus aureus among the 17 strains of Staphylococcus spp, all of them were methicillin sensitive (MSSA). 17 strains of Escherichia coli, 2 strains of Klebsiella pneumoniae and 1 strain of Klebsiella oxytoca produced ESBLs. Candida was the only pathogens of fungemia in this study in which 4 strains of Candida albicans and 11 strains of non-albicans Candida were detected. There were 120 patients(75%) with granulocytopeniain which 103 patients were agranulocytosis. 70% of the 160 paitents had hyperpyrexia. All patients received broad spectrum antibiotics therapy in the study while 58.8% received antifungal drugs at the same time. 20 patients died of septicaemia and 19 patients gave up therapy because of their conditions deteriorated.The overall improvement rate were 75.6%. Conclusions Bacteria are the main pathogens in septicaemia of immunocom- promised host and fungemia is increasing in recent years.Agranulocytosis is a risk factor of septicaemia in immunocompromised hosts. Hyperpyrexia is one of characteristic signs of these patients.