术前肠内营养支持联合改良Ivor-Lewis手术治疗食管癌对肺功能及外周血GATA3、Foxp3 mRNA表达的影响

doi:10.3969/j.issn.1006-5725.2024.21.011

Abstract

Abstract:

Objective To observe the effect of preoperative enteral nutritional support combined with modified Ivor-Lewis surgery for esophageal cancer on lung function and mRNA expression of GATA-binding protein 3 （GATA3） and forkhead protein P3 （Foxp3） in peripheral blood. Methods Sixty esophageal cancer patients who underwent modified Ivor-Lewis surgery in our hospital from January 2022 to October 2023 were selected and divided into two groups by simple random method. The control group was given conventional diet before operation， and the observation group was given enteral nutrition support before operation. The two groups were compared in terms of nutritional support. Results Both groups showed significantly decreases in one-second exertion expiratory volume/exertion lung volume （FEV1/FVC）（P < 0.05）， FVC （P < 0.05）， FEV1 （P < 0.05） and the levels of peripheral blood GATA3 （P < 0.05）， Foxp3 mRNA （P < 0.05） expression compared with those at admission （P < 0.05）， but no significant differences in pulmonary function （P > 0.05）， peripheral blood GATA3 （P > 0.05）， and Foxp3 mRNA （P > 0.05） expression between them at 1 week postoperatively. Both groups exhibited significantly lower levels of albumin， prealbumin， haemoglobin， transferrin， PNI and body mass and body mass index at admission as compared to those at one week after surgery （P < 0.05）. The observation group showed significantly higher levels of albumin， prealbumin， haemoglobin， transferrin， and PNI at 1 week postoperatively （P < 0.05）， but no significant differences in ventilation time， defecation time， drain retention time， hospitalisation time， and complication rate as compared to the control group （P > 0.05）. Conclusion Preoperative enteral nutritional support combined with modified Ivor-Lewis surgery for esophageal cancer improves postoperative nutritional status， and renders less effect on postoperative lung function and peripheral blood GATA3 and Foxp3 mRNA expression.

Key words: enteral nutrition, modified Ivor-Lewis procedure, esophageal cancer, nutritional status, pulmonary function, complication

CLC Number:

R735.1

Liang GUO,Mingxuan JIA,Wenjie MA,Hongfei QIAO,Yongsheng XU,Kefeng. GUO. Effect of preoperative enteral nutritional support combined with modified Ivor⁃Lewis surgery for esophageal cancer on lung function and GATA3 and Foxp3 mRNA expression in peripheral blood[J]. The Journal of Practical Medicine, 2024, 40(21): 3031-3035.

Figures/Tables 6

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References 25

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资料	对照组（n = 30）	观察组（n = 30）	t/χ²值	P值
年龄（x ± s）/岁	57.63 ± 7.85	58.04 ± 7.14	0.212	0.833
肿瘤直径（x ± s）/cm	2.97 ± 0.59	3.01 ± 0.62	0.256	0.799
性别			0.606	0.436
男性	18（60.00）	15（50.00）
女性	12（40.00）	15（50.00）
病理类型			0.964	0.618
鳞癌	21（70.00）	18（60.00）
腺癌	7（23.33）	8（26.67）
其他	2（6.67）	4（13.33）
肿瘤部位			0.278	0.598
胸中段	17（56.67）	19（63.33）
胸下段	13（43.33）	11（36.67）
TNM分期			1.111	0.574
Ⅰ期	15（50.00）	12（40.00）
Ⅱ期	10（33.33）	14（46.67）
Ⅲ期	5（16.67）	4（13.33）

组别	例数	FVC/L		FEV1/FVC/%		FEV1/L
组别	例数	入院时	术后1周	入院时	术后1周	入院时	术后1周
对照组	30	2.72 ± 0.32	2.32 ± 0.29^*	82.52 ± 5.96	75.63 ± 5.05^*	2.46 ± 0.36	2.05 ± 0.27^*
观察组	30	2.69 ± 0.37	2.38 ± 0.30^*	81.97 ± 6.07	76.05 ± 5.41^*	2.51 ± 0.40	2.10 ± 0.33^*
t值		0.336	0.788	0.354	0.311	0.509	0.642
P值		0.738	0.434	0.725	0.757	0.613	0.523

组别	例数	GATA3 mRNA		Foxp3 mRNA
组别	例数	入院时	术后1周	入院时	术后1周
对照组	30	0.81 ± 0.15	0.64 ± 0.12^*	0.77 ± 0.12	0.62 ± 0.10^*
观察组	30	0.80 ± 0.18	0.63 ± 0.10^*	0.78 ± 0.15	0.61 ± 0.13^*
t值		0.234	0.351	0.285	0.334
P值		0.816	0.727	0.777	0.740

指标	时间	对照组（n = 30）	观察组（n = 30）	t值	P值
体质量/kg	入院时	62.14 ± 7.24	61.63 ± 8.07	0.258	0.798
体质量/kg	术后1周	58.71 ± 5.76^*	60.47 ± 6.08	1.151	0.254
体质量指数/（kg/m²）	入院时	22.84 ± 2.03	22.76 ± 2.14	0.149	0.882
体质量指数/（kg/m²）	术后1周	21.82 ± 1.68^*	22.58 ± 1.74	1.721	0.091
白蛋白/（g/L）	入院时	42.89 ± 4.67	42.74 ± 4.46	0.127	0.899
白蛋白/（g/L）	术后1周	34.01 ± 3.36^*	36.27 ± 3.74^*	2.462	0.017
前白蛋白/（g/L）	入院时	24.25 ± 2.95	23.94 ± 3.08	0.398	0.692
前白蛋白/（g/L）	术后1周	10.17 ± 2.79^*	14.58 ± 3.08^*	5.812	< 0.001
血红蛋白/（g/L）	入院时	130.58 ± 12.74	131.01 ± 11.92	0.135	0.893
血红蛋白/（g/L）	术后1周	104.96 ± 13.41^*	112.01 ± 12.86^*	2.078	0.042
转铁蛋白/（g/L）	入院时	2.24 ± 0.48	2.21 ± 0.51	0.235	0.815
转铁蛋白/（g/L）	术后1周	1.75 ± 0.29^*	1.91 ± 0.30^*	2.100	0.040
PNI/%	入院时	42.14 ± 5.85	41.89 ± 5.73	0.167	0.868
PNI/%	术后1周	34.45 ± 6.02^*	38.83 ± 5.69^*	2.896	0.005

组别	例数	通气时间	排便时间	引流管留置时间	住院时间
对照组	30	3.02 ± 0.37	4.45 ± 0.59	5.41 ± 0.64	12.56 ± 2.12
观察组	30	2.94 ± 0.41	4.38 ± 0.51	5.34 ± 0.61	11.86 ± 1.89
t值		0.793	0.492	0.434	1.350
P值		0.431	0.625	0.666	0.182

Effect of preoperative enteral nutritional support combined with modified Ivor⁃Lewis surgery for esophageal cancer on lung function and GATA3 and Foxp3 mRNA expression in peripheral blood

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组别	例数	吻合口瘘	肺部感染	胃排空障碍	脱管、堵管	并发症
对照组	30	2（6.67）	1（3.33）	0（0）	1（3.33）	4（13.33）
观察组	30	2（6.67）	0（0）	1（3.33）	0（0）	3（10.00）
χ²值						0.162
P值						0.688

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