ObjectiveTo investigate the status of undernutrition, nutritional risk as well as nutritional support in patients with gastrointestinal tumor. MethodsIn this prospective cohort study, patients with gastrointestinal tumor were recruited from Septemper 2009 to June 2011. Patients were screened by using Nutritional Risk Screening 2002 (NRS2002) at admission. Data of the nutritional risk, application of nutritional support, complications, and tumor staging were collected. ResultsNine hundred and sixty-one patients with gastrointestinal tumor were recruited, the overall prevalence of nutritional risk was 38.9% (374/961) at admission, 49.2% （176/358） in gastric tumor and 32.8% （198/603） in colorectal tumor, respectively. The highest prevalence was found in stage Ⅳ gastric tumor 〔87.3% (48/55)〕 and colorectal tumor 〔58.8% (50/85)〕 while the lowest prevalence was found in stage ⅡA gastric tumor 〔16.1% (5/31)〕 and stageⅠcolorectal tumor 〔9.8% (6/61)〕. 62.3% (152/244) of gastric tumor patients with nutritional risk while 48.6% (144/296) without nutritional risk received nutritional support. 37.7% (92/244) of colorectal tumor patients with nutritional risk while 51.4% (152/296) without nutritional risk received nutritional support. The ratio of parental nutrition and enteral nutrition was 1.251. The rate of complications in the gastrointestinal tumor patients with nutritional risk was higher than that in the patients without nutritional risk 〔32.4% (121/374) versus 20.4% (120/587), P=0.000 0〕. For the gastrointestinal tumor patients with nutritional risk, the complication rate of the patients with nutritional support was significantly lower than that of the patients without nutritional support 〔27.5% (67/244) versus 40.8% (53/130), P=0.008 6〕. For the gas trointestinal tumor patients without nutritional risk, the complication rate of gastric tumor patients with nutritional support was significantly lower than that of the patients without nutritional support (P=0.039 6), while the complication rate was not significantly different in the colorectal tumor patients with nutritional support or not (P=0.464 7). ConclusionsPatient with gastrointestinal tumor has a high nutritional risk which is related to tumor staging. Patients with nutritional risk have more complications, and nutritional support is beneficial to the patients with nutritional risk by a lower complication rate.
ObjectiveTo investigate the clinical values of serum histidine decarboxylase (HDC), D-lactate, and alpha-glutathione S-transferase (α-GST) for diagnosing intestinal mucosal injury of patients with intestinal obstruction. MethodsThe expression levels of serum HDC, D-lactate, and α-GST in 28 patients with strangulated intestinal obstruction, 19 patients with simple intestinal obstruction, 17 patients with acute simple appendicitis, and 20 healthy volunteers were determined by enzyme linked immunosorbent assay (ELISA) before the treatment, and then the area under receiver operating characteristic curve (AUC) of these diagnostic indices were compared. In addition, the occurrence rates of systemic inflammatory response syndrome (SIRS) and infectious complications (abdominal cavity infection and pulmonary infection) were closely observed. The relevances of SIRS and infectious complications and the expression levels of these three diagnostic indices were analyzed. ResultsThe expression levels of serum HDC, D-lactate, and α-GST of the patients with strangulated intestinal obstruction were the highest among all the patients (Plt;0.01), and the expression levels of these three indices in the patients with simple intestinal obstruction were higher than those of the patients with acute simple appendicitis (Plt;0.05). The AUC of HDC (0.913) was larger than that of D-lactate (0.872) and α-GST (0.836) (P=0.000, P=0.000, respectively). When the cut off value of HDC was 31.00 μg/L, the sensitivity, specificity, false negative rate, and false positive rate of HDC were 74.5%, 94.6%, 25.5%, and 5.4%, respectively, which were all better than those of D-lactate and αGST. The occurrence rates of SIRS and abdominal cavity infection of the patients with strangulated intestinal obstruction were significantly higher than those of patients with simple intestinal obstruction (P=0.046) and acute simple appendicitis (P=0.027); while there was not significantly different of pulmonary infection among all the patients (P=0.728). The expression level of serum HDC in patients with strangulated intestinal obstruction suffered from SIRS (P=0.000) or abdominal cavity infection (P=0.002) was significantly higher than that of not-suffered from SIRS or uninfected patients. Meanwhile, the expression levels of serum D-lactate and α-GST in the patients with strangulated intestinal obstruction suffered from SIRS were higher than those of notsuffered from SIRS patients (P=0.032, P=0.021, respectively). The expression levels of HDC, D-lactate, and α-GST were significantly correlated with SIRS and abdominal cavity infection (Plt;0.05), among which the level of HDC and the incidence of SIRS had the highest correlation (r=0.608, P=0.001). ConclusionHDC may be a more effective index for diagnosing intestinal mucosal injury of patients with intestinal obstruction.
外科营养学是在现代外科学基础上发展起来的一门新兴学科。自上世纪60年代Dudrick提出的肠外营养(PN)治疗在临床实施后，应用逐渐广泛，挽救了大量肠道功能衰竭和危重患者的生命。我国的外科营养学虽起步晚于国外，整体水平还有待提高，但通过众多临床医师和科研人员的不断努力业已呈现出一派欣欣向荣的景象……
Objective To study the effect of probiotics on the change of intestinal permeability and inflammatory reaction after surgery of colorectal cancer. Methods Sixty patients who underwent colonic surgery were randomly divided into two groups: probiotic group and control group, with 30 cases in each group. Each group received nutritional support of the same nitrogen and calorie from day 3 to day 7 after operation. The patients in probiotic group were orally administrated probiotic (2 g/d) from the first day after surgery for 7 days. Every patient’s body temperature and heart rate were observed after operation, and white blood cell counts were observed before operation and on day 1, 5, 8 after operation. The levels of microbial DNA in whole blood and plasma D-lactate, and urine lactulose/mannito (L/M) ratio were measured before operation and on day 1 and day 8 after operation, respectively. In addition, the occurrence of postoperative systemic inflammatory response syndrome (SIRS) and complications of inflammation were closely observed. Results The average heart rate in postoperative 5 days was significantly lower in probiotics group than that in control group (P＜0.01). The duration of fever and the recovery time for white blood cell counts decreasing to normal were significantly less in probiotics group than those in control group (P＜0.01) as well. There was no significant difference of positive rate of microbial DNA in peripheral blood on day 1 after operation between two groups. However, the number of patients that showed positive result of microbial DNA PCR test in probiotic group （1 case, 3.3%） was significantly less than that of control group (7 cases, 23.3%）on day 8 after operation (P＜0.05). The level of plasma D-lactate in probiotic group 〔decreasing from (6.90±1.41) ng/ml on day 1 to (0.56±0.18) ng/ml on day 8〕 was also significantly lower than that in control group 〔decreasing from (6.63±1.29) ng/ml on day 1 to (0.95±0.83) ng/ml on day 8〕 on day 8 after operation (P＜0.05). Urine L/M ratio increased from 0.053±0.019 on day 1 to 0.063±0.016 on day 8 after operation in control group; while in probiotic group, the ratio decreased from 0.047±0.012 on day 1 to 0.031±0.008 on day 8 after operation, and there was significantly statistical difference of the ratio between two groups on day 8 (P＜0.01). There was no significant difference of the occurrence rate of SIRS and complications of inflammation between two groups (Pgt;0.05). Conclusion Probiotics can decrease intestinal permeability and maintain the intestinal barrier function after operation. It may be helpful for the recovery of patients with early inflammatory response after surgery of colorectal cancer.
Objective To observe the effect of parenteral nutrition (PN) on the protein storage and immunofunction in patients with liver cirrhosis. Methods PN regimes consisted of nonprotein calories (NPC) 20-25 kcal/(kg·d) and nitrogen 0.15-0.20 g/(kg·d), the energy ratio of the glucose and fat emulsion was 2∶1. The PN solution was infused by total nutrition admixture (TNA), 12-16 hours per day for 7 days in 21 liver cirrhosis patients. Perior to the surgery and at 1st, 4th, 7th postoperative day, serum pre-Alb, transferrin (TSF), immunofunction (IgG, IgA, IgM, IgE, CH50, C3, C4, CD3, CD4, CD8, NKC), and nitrogen balance were tested. Results Serum pre-Alb, TSF, nitrogen balance and IgG, IgE, CH50, CD3, CD4, NKC were significantly decreased (Ｐ＜0.05), but the foregoing indices were higher than those of postoperative 1, 4d as compared with postoperative 7d. Conclusion These results bly indicated that postoperative nutritional support is safe and useful, and improve the patient’s nutritional status and immunofunction.
Objective To study the protective effect of glutamine on the intestinal mucosal antioxidation in endotoxemic rats. Methods Twenty-eight male Wistar rats were randomly divided into three groups, group A:parenteral nutrition supplemented with glutamine, group B:TPN without glutamine,and group C:normal control. Endotoxemia was induced by continous intravenous infusion of lipopolysaccharide(LPS) at a dose of 2 mg/kg per day throughout the 5-day study period. The mucosal protein、DNA、ATP、SOD、MDA、GSH、sIgA were determined. Results The mucosal protein、DNA、ATP、SOD、GSH and sIgA content in endotoxic rats were markedly decreased, MDA was increased as compared with normal control(P＜0.05). The former indices in group A were improved and MDA content was decreased as compared with group B(P＜0.05). Conclusion Glutamine can improve gut energy metabolism, decrease the extent of mucosal injury of free radicals, and give an protective effect on the mucosal probably by increasing GSH.
Tostudycorrelationbetweenexpressionofp21rasandnm23H1geneandstatusoflymphnodemetastasis(LNM)ingastriccancer.Therateofpositiveexpressionofp21rasandnm23H1werestudiedin80casesbyLSABimmunohistochemicaltechnique.Results:Theresultsshowedthatthepositiveexpressionofp21rasincaseswithLNMwas62.5%,higherthanthatofcaseswithoutLNM(42.5%)(Plt;0.01);thepositiverateofnm23H1incaseswithLNMwas27.5%,lowerthanthatofcaseswithoutLNM(47.5%)(Plt;0.01).Thepositiverateofp21rasincaseswith1-3LNMwaslowerthanthatofcaseswith4-7orgt;8LNM(Plt;0.01);thepositiverateofp21rasincaseswithN1waslowerthanthatofcaseswithN2orN3(Plt;0.01),therewasnopositiveexpressionofp21rasincaseswithN3(7cases).Thepositiverateofnm23H1was44.4%incaseswith1-3LNM,higherthanthatofcaseswith3-7(25.0%)orgt;8LNM(0%)(Plt;0.01),thepositiverateofnm23H1incaseswithN1wasmarkedlyhigherthanthatofcaseswithN2orN3,therewasnopositiveexpressionofnm23H1incaseswithN3(6cases).Conclusions:Theresultssuggestthattheexpressionofp21rasandnm23H1ingastriccancerplayanimportantroleintheinvasiongrowthandmetastasisoftumor,andmayserveasamarkerofpredictingmetastasisandprognosisofgastriccancer.
Objective To assess the tolerance of preoperative carbohydrate-rich beverage, to determine its effect on postoperative insulin resistance and analyze its potential mechanism. Methods Thirty-two patients undergoing elective colorectal cancer resection were recruited to this randomized controlled study and assigned to two groups at random. Patient in control group was fasted before operation, while patient in study group was given oral water. Homeostasis model assessment (HOMA) indexes, activity of PTK, and mRNA and (or) protein expressions of PKB, PI3K and GluT4 were measured before and (or) immediately after surgery. Furthermore preoperative well-beings of patients were studied. Results Among well-beings, feeling of thirst, hunger and anxiety tended to be better in patients receiving carbohydrate-rich beverages compared with fasted ones (P＜0.05). Whole body insulin sensitivity decreased by 33% in the study group while 38% in the control group (P=0.007 2), and the activity of PTK, expressions of PI3K and PKB in study group were higher than those in control group (P＜0.05， P＜0.01), but no significantly difference was observed about GluT4 in both groups (Pgt;0.05）. Conclusion Preoperative consumption of carbohydrate-containing fluids is safe and effective. Provision of carbohydrate energy source prior to surgery may attenuate immediate postoperative insulin resistance. A carbohydrate-rich drink enhances insulin action at the time of onset of anaesthesia or surgery by activating three kinases named PTK, PI3K, PKB which are key enzymes in pathway of insulin signal transduction. It is likely to explain the effects on postoperative insulin resistance.
【Abstract】 Objective To study the effects of glutamine (Gln) combined with growth hormone （GH） on the levels of cytokine (TNF-α, IL-1, IL-6), coritsol and amino acid metabolism in septic rats. Methods Ten out of 79 SD rats were randomly collected as the control group. Thirty of 69 septic SD rats, which were made by cecal ligation and perforation (CLP) method and were given parenteral nutrition (PN) lived to day 6. They were also randomly divided into three groups as follows: septic group (n=10), parenteral supplemented glutamine group (Gln group, n=10), and Gln combined with GH (Gln+GH group, n=10). On the 6th day, blood drew from portal veins of the dead rats was used to detect the levels of TNF-α， IL-1， IL-6 and cortisol by ELISA. The plasma concentrations of free amino acids were determined by amino acid auto-analyzer. The muscle tissue of extensor digitorum longus was used to determine 3-methyl-histidine (3-MH) by high performance liquid chromatographic (HPLC). Results Except for the control group, most rats developed celiac abscess, hepatic abscess and pulmonary infection. The serum levels of TNF-α, IL-1, IL-6 and cortisol were significantly higher in the septic group than those of the other three groups, and they were significantly lower in the Gln+GH group than those of the Gln group, P＜0.05. Compared with the other three groups, the concentration of total amino acid in the septic group increased more, among which the glutamine and the branched chain amino acids were prominent. Most of concentrations of the amino acids decreased in the Gln group and the Gln+GH group, and the decreased amplitude of the Gln+GH group was larger, P＜0.05, albeit its level of Gln markedly increased. The concentration of 3-MH in muscle tissue was the highest in septic group, and it was significantly higher in the Gln group than that of the Gln+GH group, P＜0.01. ConclusionIt may be necessary to supplement GH combined with Gln as the content of PN to decrease cytokine levels and im-prove amino acid metabolism for septic case.