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目的:研究L-精氨酸(L-Arg)对围手术期胃癌病人炎性反应和免疫功能的影响。方法:将围手术期胃癌病人随机分为研究组和对照组,研究组(n=33)行营养支持加L-Arg治疗,L-Arg 0.4 g/(kg.d)通过静脉给予;对照组(n=30)行营养支持治疗加等量的等渗盐水。能量供给为125.4 kJ/(kg.d),氮量为0.2 g/(kg.d),治疗10 d。观察胃癌病人术前3 d、术后第3和第7天血清C-反应蛋白(CRP)、白细胞介素-2(IL-2)、IL-6、IL-10、肿瘤坏死因子-α(TNF-α)、T淋巴细胞亚群CD4+、CD8+水平和CD4+/CD8+比值的变化。结果:术后第7天,研究组病人血IL-2、TNF-α水平和CD4+/CD8+比值均明显高于对照组和术前3 d,而血液CRP和IL-10水平明显低于对照组和术前3 d。术后第7天,CRP水平明显低于术后第3天。结论:L-Arg可影响胃癌病人的炎性反应水平,下调具有促进肿瘤生长能力的炎性因子水平,上调胃癌病人细胞免疫应答。
Objective: To study the effect of L-arginine on the inflammatory response and immune function in patients with gastric cancer during perioperative period. Methods: The patients with perioperative gastric cancer were randomly divided into study group and control group. The study group (n = 33) received nutrition support plus L-Arg treatment. L-Arg 0.4 g / (kg · d) (n = 30) nutrition support treatment plus equal amount of isotonic saline. The energy supply was 125.4 kJ / (kg · d) and the nitrogen was 0.2 g / (kg · d) for 10 days. The levels of serum C-reactive protein (CRP), interleukin-2 (IL-2), IL-6, IL-10 and tumor necrosis factor-α TNF-α), T lymphocyte subsets CD4 +, CD8 + levels and CD4 + / CD8 + ratio changes. Results: On the 7th postoperative day, the levels of blood IL-2, TNF-α and the ratio of CD4 + / CD8 + in the study group were significantly higher than those in the control group and 3 days before operation, while the blood levels of CRP and IL-10 were significantly lower than those in the control group And 3 days before surgery. On the 7th postoperative day, the level of CRP was significantly lower than that on the 3rd postoperative day. Conclusion: L-Arg can affect the level of inflammatory response in patients with gastric cancer, down-regulate the level of inflammatory cytokines that promote tumor growth and up-regulate the cellular immune response in gastric cancer patients.