Effects of perioperative immunonutrition on cell-mediated immunity, T helper type 1 (Th1)/Th2 differentiation, and Th17 response after pancreaticoduodenectomy
Effects of perioperative immunonutrition on cell-mediated immunity, T helper type 1 (Th1)/Th2 differentiation, and Th17 response after pancreaticoduodenectomy
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DOI：
10.1016/j.surg.2010.01.017
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发表时间：
2010-09-01
期刊：
影响因子：
3.8
通讯作者：
Miyazaki, Masaru
中科院分区：
文献类型：
--
作者：
Suzuki, Daisuke;Furukawa, Katsunori;Miyazaki, Masaru
背景免疫营养素减少感染并发症的机制仍然知之甚少。这项前瞻性随机研究旨在确定免疫营养素是否影响以下因素：细胞介导的免疫、辅助性T细胞1型（Th 1）和Th 2细胞的分化、产生白细胞介素（IL）-17的CD 4（+）辅助性T细胞（Th 17）应答以及胰腺癌切除术后感染并发症的发生率。将30例胰腺癌切除术患者分为3组。围手术期组中的10名患者在手术切除前接受富含精氨酸、ω-3脂肪酸和RNA的免疫增强饮食5天，手术切除后通过肠内输注延长。术后组10例，术前给予相同的营养强化配方，术后早期肠内输注，不给予人工营养。对照组10例，术后给予全肠外营养。主要终点是免疫应答;次要终点是感染并发症的发生率。伴刀豆球蛋白A（Con A）或植物血凝素（PHA）刺激的淋巴细胞增殖和自然杀伤细胞活性显着高于围手术期组比其他组。围手术期组中T-bet、干扰素-γ（IFN-γ）、相关孤儿受体γ t（ROR γ t）和白细胞介素-17 F（IL-17 F）的信使RNA（mRNA）表达水平显著高于其他组。围手术期组感染性并发症发生率明显低于其他组。围手术期免疫营养素可减少重大应激性手术切除后应激诱导的免疫抑制。Th 1/Th 2分化和Th 17应答的调节可能在这种免疫效应中起重要作用。（Surgery 2010;148：573-81.）
Background. The mechanisms of immunonutrition on reducing infectious complications are still poorly understood. This prospective randomized study was designed to determine whether immunonutrition influences the following factors: cell-mediated immunity, differentiation of T helper type 1 (Th1) and Th2 cells, interleukin (IL)-17-producing CD4(+) helper T (Th17) cell response, and infectious complication rate after pancreaticoduodenectomy.Methods. Thirty patients who underwent pancreaticoduodenectomy were divided into 3 groups. Ten patients in the perioperative group received immune-enhancing diets enriched with arginine, omega-3 fatty acids, and RNA for 5 days before operative resection, which was prolonged after operative resection by enteral infusion. Ten patients in the postoperative group received early postoperative enteral infusion of the same enriched formula with no artificial nutrition before operative resection. Ten patients in the control group received total parenteral nutrition postoperatively. The primary endpoint was immune responses; the secondary endpoint was the rate of infectious complications.Results. Concanavalin A (Con A)- or phytohemagglutinin (PHA)-stimulated lymphocyte proliferation and natural killer cell activity were significantly higher in the perioperative group than in the other groups. Messenger RNA (mRNA) expression levels of T-bet, interferon-gamma (IFN-gamma), related orphan receptor gamma t (ROR gamma t), and interleukin-17F (IL-17F) were significantly higher in the perioperative group than in the other groups. In the pen operative group, the rate of infectious complications was significantly reduced compared with that in the other groups.Conclusion. Pen operative immunonutrition reduced stress-induced immunosuppression after a major stressful operative resection. The modulation of Th1/Th2 differentiation and Th17 response may play important roles in this immunologic effect. (Surgery 2010;148:573-81.)