腹腔镜胃癌根治术对胃癌患者能量代谢外周血T细胞亚群和患者肠屏障功能机体炎性应激水平和免疫功能的影响

doi:10.3969/j.issn.1006-6233.2021.07.028

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摘要 目的: 探讨腹腔镜胃癌根治术对胃癌患者能量代谢、外周血T细胞亚群、肠屏障功能、炎性应激水平和免疫功能的影响。方法: 选取2017年6月至2020年6月我院收治的142例胃癌患者为研究对象。根据手术方法将纳入的142例患者分为腹腔镜手术组(观察组,n=75)和开腹手术组(对照组,n=67)。比较两者患者手术前后能量代谢[白蛋白(ALB)、前白蛋白(PA)、视黄醇结合蛋白(RBP)、转铁蛋白(TRF)]、肠屏障功能[二胺氧化酶(DAO)、D-乳酸]、炎性应激水平[C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、外周血T细胞亚群(CD4⁺、CD8⁺、CD4⁺/CD8⁺)、免疫球蛋白(IgA、IgG、IgM)的变化情况。结果: 术后3d,两组患者血清ALB、PA、RBP、TRF、TNF-α、IgA、IgG、IgM水平以及外周血CD4⁺、CD4⁺/CD8⁺水平均较术前降低(P<0.05);术后3d,两组患者血浆DAO、D-乳酸及血清CRP水平均较术前升高(P<0.05);术后1d,两组患者血清IL-6水平较术前升高(P<0.05);观察组患者上述指标手术前后改变幅度均低于对照组(P<0.05)。结论: 与开腹手术比较,腹腔镜胃癌根治术对患者能量代谢、肠屏障功能、炎性应激水平和免疫功能的影响较小,有利于术后恢复。

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关键词 ：腹腔镜, 胃癌根治术, 能量代谢, 肠屏障功能, 炎性应激反应, 免疫功能

Abstract：Objective: To explore the effects of laparoscopic radical gastrectomy on energy metabolism, peripheral blood T cell subsets, intestinal barrier function, body’ s inflammatory stress level and immune function in patients with gastric cancer. Methods: A total of 142 patients with gastric cancer admitted to our hospital from June 2017 to June 2020 were selected as the research subjects. According to the surgical methods, 142 patients were divided into laparoscopic surgery group (observation group, n=75) and open surgery group (control group, n=67). The energy metabolism [albumin (ALB), prealbumin (PA), retinol binding protein (RBP), transferrin (TRF)], intestinal barrier function [diamine oxidase (DAO), D-lactic acid], inflammatory stress level [C reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], peripheral blood T cell subsets (CD4⁺, CD8⁺, CD4⁺/CD8⁺) and immunoglobulins (IgA, IgG, IgM) were compared between the two before and after surgery. Results: At 3 days after surgery, the levels of serum ALB, PA, RBP, TRF, TNF-α, IgA, IgG and IgM and peripheral blood CD4⁺ and CD4⁺/CD8⁺in the two groups were decreased compared with those before surgery(P<0.05). At 3d after surgery, the levels of plasma DAO and D-lactic acid and serum CRP in the two groups were increased compared with those before surgery (P<0.05). At 1 day after surgery, the level of serum IL-6 in the two groups was higher than that before surgery (P<0.05). The changes of above indexes before and after surgery in observation group were lower than those in control group (P<0.05). Conclusion: Compared with open surgery, laparoscopic radical gastrectomy has less effect on energy metabolism, intestinal barrier function, inflammatory stress level and immune function, and it is beneficial to postoperative recovery.

Key words： Laparoscopy Radical gastrectomy Energy metabolism Intestinal barrier function Inflammatory stress response Immune function

基金资助:攀枝花市社会科学规划项目,(编号:攀社立【2020】37号)

引用本文:

代梦霜, 张凤, 贾婷婷, 张泽玉, 付再碧, 敬利春, 马银华. 腹腔镜胃癌根治术对胃癌患者能量代谢外周血T细胞亚群和患者肠屏障功能机体炎性应激水平和免疫功能的影响[J]. 河北医学, 2021, 27(7): 1186-1190.
DAI Mengshuang, ZHANG Feng, JIA Tingting, et al. Effects of Laparoscopic Radical Gastrectomy on Energy Metabolism Peripheral Blood TCell Subsets Intestinal Barrier Function Body's Inflammatory Stress Level and Immune Function in Patients with Gastric Cancer. HeBei Med, 2021, 27(7): 1186-1190.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.07.028 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I7/1186

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