<Original Articles>Studies on Early Enteral Nutrition for Patients with Gastric Cancer from the View of Immunity

Abstract

The enteral nutrition after operation for gastric cancer patients with special reference to its immunological improving effect was examined. The subjects were 25 patients who underwent an operation and they were classified into 2 groups by the postoperative nutritional control method. E group: patients who recieved enteral nutrition after operation (n=12) and T group those who reviewed TPN postoperatively (n=13). In the 25 subjects the serum proteins, nitrogen balance and 3-methylhistidine (3-Mehis) were measured before and after the operation. The total lymphocyte counts were measured before and after operation. The total lymphocyte subsets and NK cell activity were determined with monoclonal antibodies. Nutritioaly, there was no significant difference in the serum proteins and nitrogen balance and 3-Mehis/Cr ratio also showed no significant difference. Immunologically, an improving effect was observed in E group postoperatively with CD4_+CD45R_-Leu8_-(helper T) cell subpopulation, CDS_+CD11b_-(cytotoxic T) cell subpopulation and CD3_-CD16_+CD56_+(NK-LAK) cell subpopulation.

胃癌術後早期における経腸栄養法について免疫能の改善効果の面から検討を加えた. 進行胃癌症例25例を対象とし, 術後の栄養管理法により以下の2群に分類した. E群: 術後経腸栄養を行った群(n=12), T群: 術後中心静脈栄養を行った群(n=13). 両群において術前, 術後にわたり栄養学的パラメータとしてTP, Alb, RTP, 窒素平衡, 3-MeHis/Cr 比を測定した. また免疫学的パラメータとして末梢血から総タンパク, モノクローナル抗体によるリンパ球サブセット, さらに NK 細胞活性を測定した. 栄養学的な検討では血漿タンパクの推移に差を認めず, 窒素平衡, 3MeHis/Cr 比の変化においても両群間に有意差を認めなかった. 一方免疫学的な検討ではCD8_+CD11b_-(cytotoxic T), CD4_+CD4SR_-Leu8_-(helper T)細胞比率がE群で術後高値を示し, 非特異的免疫細胞として CD3_-CD16_+CD56_+(NK-LAK) 細胞比率が術後E群において高値を示した. 以上より胃癌術後早期の経腸栄養法により免疫能の改善効果が示唆された.