ANN SURG：结肠癌术前营养缺乏或可增加术后感染率

　　一项发表于2012年11月26日在线出版的《外科学年鉴》（Annals of Surgery）杂志上的研究结果表明：结肠癌患者GALT缺乏肠内营养运送可降低T细胞与IgA产生细胞以及成熟树突状细胞数目。

　　在营养补充方式是否对GALT数目与/或表型产生影响方面，目前尚缺乏相关临床证据。而GALT衰退对临床预后的影响也同样不甚明确。针对这种情况，日本防卫医科大学Koichi Okamoto博士等人进行了一项研究，他们对发生术后传染性并发症的情况下，术前饮食因素对肠道相关淋巴组织（GALT）细胞数目的影响进行考察。

　　该项研究所招募对象排除了因肿瘤而导致完全性结肠梗阻的患者。共包括两个研究项目，研究项目1内容为，自62例于1997年至2004年间接受右半结肠切除术治疗的患者 [术前肠外营养（PN）：n=15, 术前经口营养（OF）：n=47] 中，获取其回肠末端切除标本，并通过免疫组化染色法，对固有层(LP)与上皮内空间中的T细胞、IgA产生细胞以及成熟和未成熟的树突状细胞(DC)进行计数。研究项目2为，对在此阶段内341例（PN： n=99，OF：n=242）接受结肠切除术的结肠癌患者术后并发症情况进行考察。

　　研究人员在研究项目1中发现，肠外营养组患者GALT固有层与上皮内空间中的T细胞数目和固有层中的IgA产生细胞数目均显著低于经口营养组患者。尽管两组患者树突状细胞总数（包括成熟与未成熟树突状细胞）类似，但是肠外营养组患者GALT固有层中成熟树突状细胞显著低于经口营养组患者。根据研究项目2，研究人员发现，肠外营养组患者的总体感染性并发症、手术部位感染、肺炎、传染性结肠炎以及中心静脉导管感染发病率明显较高。

　　Koichi Okamoto博士等人总结认为，与动物模型结果一致，结肠癌患者GALT缺乏肠内营养运送可降低T细胞与IgA产生细胞以及成熟树突状细胞数目。此外，该研究还证实，GALT变化与传染性并发症发病率存在密切联系。

与结肠癌相关的拓展阅读：

• 结肠癌术前营养缺乏或可增加术后感染率
• 槲寄生治疗结肠癌
• JNCI：饮食血糖负荷增加III期结肠癌患者肿瘤复发风险
• 科学家发现一使结肠癌转移关键过程
• JNCI：高碳水化合物饮食使结肠癌复发风险升高
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Lack of Preoperative Enteral Nutrition Reduces Gut-Associated Lymphoid Cell Numbers in Colon Cancer Patients: A Possible Mechanism Underlying Increased Postoperative Infectious Complications During Parenteral Nutrition

Objective

To examine preoperative dietary influences on gut-associated lymphoid tissue (GALT) cell number in the context of postoperative infectious complications.

Background

There is little clinical evidence regarding whether nutritional routes affect GALT size and/or phenotype. The influence of GALT atrophy on clinical outcomes is also unclear.

Method

Patients with complete obstruction of the colon due to a tumor were excluded from this study. 

Study 1. Resected terminal ileum specimens, from 62 patients [preoperative parenteral nutrition (PN): n = 15, preoperative oral feeding (OF): n = 47] who underwent right colectomy during the period from 1997 to 2004 at our department, were immunohistochemically stained for counting numbers of T, IgA-producing, and mature and immature dendritic cells (DCs) in the lamina propria (LP) and intraepithelial space.

Study 2. We reviewed 341 patients (PN: n = 99, OF: n = 242) with colon cancer who underwent colectomy during this period for postoperative complications.

Results

Study 1. T cell numbers in the LP and intraepithelial space and IgA-producing cell number in the LP were significantly lower in the PN than in the OF group. Mature DC number in the LP was significantly lower in the PN than in the OF group, whereas total DC numbers (both mature and immature DC) were similar in the 2 groups.

Study 2. The PN group had significantly higher rates of total infectious complications, surgical site infection, pneumonia, infectious colitis, and central venous catheter infection.

Conclusions

Lack of enteral delivery of nutrients reduces numbers of T and IgA-producing cells, as well as mature DCs, in GALT of colon cancer patients, as it does in animal models. A close association between GALT changes and infectious complication morbidity was confirmed.