Effect Of Parenteral Nutrition Adding Argining And Glutamine On Nutrition Status, Immune Function And Tress Status After Radical Treatment Of Gastric Cancer Patients

Purpose To evaluate the effect of Arginine and Glutamine enriched PN onnutrition status, immune function, stringent status and postoperation infectioncomplications after radical treatment of gastric cancer patients.Methods Sixty patients with gastric cancer were randomly, equally dividedinto 4 groups: Arg group(Arginine enriched PN,n=15), Glu group (Glutaminesupplemented PN,n=15), Arg+Glu group(Arginine and Glutamine enrichedPN,n=15)and standard PN group (routing group,n=15). The all PN formulaewere isonitrogenous and isocaloric, which commenced on the first morningafter operation and ran continuously for 7 consecutive days. 20g·d-1 Argininewas added into PN in the Arg group, 0.4g·kg-1·d-1 Glu enriched PN in theGlu group, while in the Arg+Glu group the doses of Arg and Glu were equalto those in the Arg group and Glu group.On preoperation and the 8th day ofpostoperation, albumin(ALB), pre-albumin(PAB), transferrin(TF),CD3,CD4, CD8 , the ratio of CD4/CD8, IgA, IgM, IgG, C3, C4 and C reactingprotein(CRP)were analyzed, and postoperative infections were observed too.The other 15 cases of benign diseases, including 9 cases of mammary glandfibroma and 6 cases of thyroid gland adenoma, which dated for selectiveoperation were fetched as blank group in the same term separately.Results On preoperation, the concentration of ALB, PAB, TF, CD3, CD4,IgA, IgM, IgG, C3, C4 and the ratio of CD4/CD8 of 60 patients with gastriccancer were significantly less than blank group(P < 0.05), while theconcentrations of CD8 and CRP was obviously higher than those in blankgroup (P<0.05). On the 8th day of postoperation(POD+8), in the Rou groupthe concentration of PAB increased than that on preoperation, while PAB andTF decreased;in the Arg group, Glu group and Arg+Glu group, theconcentrations of PAB were all significantly more than those onpreoperation(P<0.05),but there weren't significant difference between eachgroup,and the level of decrease were less than that in the Rou group.On thePOD+8,in the Arg group, Glu group and Arg+Glu group the concentrationsof IgA, IgM, IgG were obviously higher than those in standard PN group insynchronization (P<0.05), however between each other, there weren'tsignificant difference in those concentration. On the POD+8, in the Arggroup and Glu group the percents of CD3, CD4 and the ratio of CD4/CD8were obviously higher than those in the homochronous standard PN group (P<0.05), which were visibly lower than those in Arg+Glu group(P<0.05),however there weren't significant difference in those percents between theArg group and the Glu group too; there were reversed results in the percent ofCD8 and the concentration of CRP , C3, C4. On the POD+8, those, thepercent of CD3, CD4, the ratio of CD4/CD8 and the concentration of CRP, inthe Arg+Glu group were extremely different compared with those in thehomochronous standard PN group (P<0.01). On the postoperation, thenumbers of infectional man-time in Arg group, Glu group and Arg+Glu groupwere all lower than those in the standard PN group (P<0.05).while thereweren't significant difference in infectional man-time between the Arg group,the Glu group and the Arg+Glu group.Conclusions The using of PN adding Argining or(and) Glutamine isperformed in radical treatment of gastric cancer patients, which not only willprevent and retrieve low nutritional station,stimulate immune cell,strengthenthe function of immune response,but also will adjust and control thegeneration and releasing of the inflammation factor; consequently which willlower systemic inflammatory reaction, quicken postoperative recovery, andreduce the rate of postoperative complications. Among which the jointlyusing Arg and Glu is stronger than the using Arg or Glu alone in enhancingthe cellular immunue fuction and suppressing the inflammatory reaction inradical treatment of gastric cancer patients.