口服免疫营养对膀胱癌患者细胞因子谱影响的初步随机对照研究

　　重大手术后应激往往引起患者炎症反应及免疫功能失调，如辅助型T细胞Th1-Th2的失调，容易造成术后感染等并发症。在行根治性膀胱切除手术的患者中，给予术前专用免疫营养（SIM）可能改善这一状况。

　　美国堪萨斯大学医学中心将择期行根治性膀胱切除术的29例男性患者随机分成两组，在术前和术后各行5天营养支持：SIM组14人，口服营养补充（ONS）组（对照组）15人，分别口服等氮等热量营养。

　　结果发现，术后两天SIM组血浆白介素（IL）-6水平较ONS组明显降低（P=0.02），表明SIM可改善术后炎症反应。此外，相比ONS组，术后应激所致辅助型T细胞失衡在一定程度上被SIM逆转。

JPEN J Parenter Enteral Nutr. 2017;41(2):279.

Effects of oral immunonutrition on cytokine profiles in bladder cancer patients: a pilot randomized controlled clinical trial.

Abigail Stanley; Misty D. Bechtel; Thomas M. Yankee; Prabhakar Chalise; Lauren Hand; Jeffrey M. Holzbeierlein; Jill M. Hamilton-Reeves.

University of Kansas Medical Center, Kansas City, Kansas, USA.

PURPOSE: Major surgeries disrupt T helper (Th)1-Th2 balance to a Th2 predominant response, which impairs cell-mediated immunity, leaving patients more susceptible to infection. We evaluated T-cell differentiation and the inflammatory response to radical cystectomy (RC) with perioperative specialized immunonutrition (SIM) compared with a control.

METHODS: Twenty-nine men with bladder cancer scheduled for RC were randomized to oral SIM (n = 14) or a calorie- and nitrogen-matched oral nutrition supplement (ONS, n = 15) for 5 days before and 5 days after RC. Blood was collected at baseline, during surgery (3 hours after incision), and on postoperative days 2, 14, and 30. Plasma interleukin (IL)-6 was analyzed using enzyme-linked immunosorbent assay. The Th1-Th2 balance of inflammatory response was measured by analyzing the interferon (IFN)γ/IL-4 and tumor necrosis factor (TNF)a/IL-13 ratios from stimulated CD4+ T cells.

RESULTS: Plasma IL-6 was significantly lower in the SIM group compared with the ONS group on postoperative day 2 (P = .020). The change in the TNFa/IL-13 ratio from baseline to 3 hours postincision was significantly different (P = .027) in the SIM group compared with the ONS group. The change in the IFNγ/IL-4 ratio from baseline to 3 hours postincision showed the same trend but was not statistically significant (P = .079).

CONCLUSIONS: Proinflammatory cytokine IL-6 was lower in the SIM group than the ONS group 2 days after surgery. The Th1-Th2 ratios suggest that skewed T-helper homeostasis from RC surgery is counteracted by consuming SIM. Modulating T-cell differentiation and the inflammatory response after RC surgery may help reduce common postoperative complications.

FINANCIAL SUPPORT: The Radical Cystectomy and Nutrition (RC Nutrition) trial was supported by grant IRG-09-062-05 from the American Cancer Society (JHR), a Nestlé HealthCare Nutrition Research Grant (JHR). Support for JHR was provided by a mentored research training award, the KL2 TR000119-04, a Clinical and Translational Science Award grant from the National Center for Advancing Translational Sciences (NCATS) awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or NCATS.

DOI: 10.1177/0148607116686023