胃癌患者喂养不耐受的影响因素分析及与炎症因子的关系研究

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摘要目的分析胃癌术后患者早期肠内营养喂养不耐受的影响因素,探讨炎症因子与胃癌患者术后肠内营养喂养不耐受的相关性。方法选取 2022 年 6 月至 2024 年 4 月期间在江苏省中医院消化肿瘤外科行胃癌根治术并实施早期肠内营养的 200 例患者,依据患者是否存在肠道不耐受症状,分为喂养耐受组及喂养不耐受组。收集两组患者术中出血量、手术时长、术后首次下床时间以及血清炎症因子水平等病例资料,对其进行回顾性分析。结果喂养不耐受组患者年龄(65. 65±15. 11)岁、营养风险筛查 2002(NRS 2002)评分(3. 31±1. 34)分、术中出血量(92. 74±48. 36)ml、手术时长(212. 53±48. 51)min、术后首次下床时间(4. 58±2. 06)d,均高于喂养耐受组(P<0. 05);喂养不耐受组患者前白蛋白水平(126. 61±52. 15) g / L,低于喂养耐受组(P<0. 05),全球领导人营养不良倡议(GLIM)评估营养不良的患者更容易发生喂养不耐受(P<0. 05),对比两组患者血清炎症指标水平,喂养不耐受组患者血清 TNF-α、白细胞介素(IL) -6、IL-8、IL-1β、CRP 水平分别为[(6. 17±2. 73) pg / ml,( 48. 29± 18. 49)pg / ml,(41. 64±16. 34)pg / ml,(21. 6±12. 69)pg / ml,(70. 42±38. 09) mg / L],均高于喂养耐受组(P<0. 05)。多因素 Logistic 回归分析显示年龄、NRS 2002、GLIM 营养不良评定、术中出血量是肠内营养耐受不良的危险因素。胃癌术后患者炎症因子 IL-6、IL-8、IL-1β 与胃癌术后患者炎症因子 IL-6(r=0. 388,P=0. 028),IL-8(r = 0. 351,P= 0. 005),IL-1β(r = 0. 323,P= 0. 011)与喂养不耐受呈正相关。结论年龄、NRS2002、GLIM 评定营养不良、术中出血量是胃癌术后患者喂养不耐受的危险因素,炎症因子表达与喂养耐受程度显著相关。

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	黄晓钰
	吴丽红
	王永磊

关键词 ：喂养不耐受, 影响因素, 血清炎症因子, 胃癌术后, 早期肠内营养, 耐受性, 相关性, 肠道微生态

Abstract：Objective To analyze the influencing factors of early enteral nutrition feeding intolerance in postoperative patients with gastric cancer and to explore the correlation between inflammatory factors and enteral nutrition feeding intolerance in postoperative patients with gastric cancer. Method A total of 200 patients with gastric cancer who underwent radical gastrectomy and early enteral nutrition at the Jiangsu Province Hospital of Traditional Chinese Medicine from June 2022 to April 2024 were selected and their clinical data were retrospectively analyzed. Result In the feeding intolerance group the age was 65. 65 ± 15. 11 years old the nutritional risk screening NRS 2002 score was 3. 31±1. 34 the intraoperative blood loss was 92. 74±48. 36 ml the operation time was 212. 53±48. 51 min and the first time to get out of bed after operation was 4. 58±2. 06 days. The level of prealbumin in the feeding intolerance group was 126. 61±52. 15 g / L which was lower than that in the TEN tolerance group P < 0. 05 . Patients with malnutrition assessed by GLIM were more likely to develop feeding intolerance P < 0. 05 . The levels of TNF-α IL-6 IL-8 IL-1β and CRP in feeding intolerance group were 6. 17±2. 73 pg / ml 48. 29±18. 49 pg / ml 41. 64±16. 34 pg / ml 21. 6±12. 69 pg / ml 70. 42±38. 09 mg / L respectively. They were higher than the enteral nutrition tolerance group P < 0. 05 . Multivariate Logistic regression analysis showed that age NRS 2002 score GLIM score of malnutrition and intraoperative blood loss were risk factors for enteral nutrition intolerance. IL- 6 IL- 8 and IL- 1β are positively correlated with feeding intolerance in postoperative patients with gastric cancer. Conclusion Age NRS 2002 score GLIM score of malnutrition and intraoperative blood loss are the risk factors of feeding intolerance in postoperative patients with gastric cancer. The expression of inflammatory factors is significantly correlated with feeding tolerance.

Key words： Feeding intolerance Influencing factors Serum inflammatory factors After gastric cancer surgery Early enteralnutrition Tolerance Correlation Intestinal microecology

基金资助:江苏省中医药科技发展计划项目(2023NL-047-02)

通讯作者: 吴丽红,电子邮箱:wulihong0213@163.com

引用本文:

黄晓钰,吴丽红,王永磊. 胃癌患者喂养不耐受的影响因素分析及与炎症因子的关系研究[J]. 肿瘤代谢与营养电子杂志, 2024, 11(6): 805-810.
Huang Xiaoyu, Wu Lihong, Wang Yonglei. Relationship between feeding intolerance and inflammatory factors in patients with gastric cancer and analysis of influencing factor. Electron J Metab Nutr Cancer, 2024, 11(6): 805-810.