Abstract:

Objective To evaluate the effects of immune-enhanced enteral nutritional support on the immune and nutritional function in elderly patients with gastric cancer after total gastrectomy. Methods Eighty-four elderly patients with gastric cancer undergoing total gastrectomy were randomly divided into glutamine-enhanced enteral nutrition  group (Gln group, n=28), conventional enteral nutrition group (EN group, n=28) and parenteral nutrition group (PN group, n=28). The time of anal exhaust after operation, incidences of postoperative complications and duration of hospitalization were observed. Serum total protein, albumin, proalbumin and transferrin were measured 1 d before operation, 2 d and 10 d after operation. Ten days after operation, the percentages of CD4+T cells and CD8+T cells in peripheral blood were measured, the ratio of CD4+T cells to CD8+T cells （CD4+/CD8+）was calculated, and the serum IgM and IgG were detected. Results The time of anal exhaust after operation and duration of hospitalization in Gln group and EN group were significantly shorter than those in PN group (P<0.05), while there was no significant difference in the incidences of postoperative complications among three groups (P>0.05). Two days after operation, the mass concentrations of serum total protein, albumin, proalbumin and transferrin were significantly lower than those before operation in three groups (P<0.05). Ten days after operation, the mass concentrations of serum total protein, albumin and proalbumin in Gln group and EN group were significantly higher than those in PN group (P<0.05). Ten days after operation, the percentages of CD4+T cells and CD8+T cells in peripheral blood, CD4+/CD8+ , and serum mass concentrations of IgM and IgG in Gln group recovered to those before operation, and were significantly higher than those in EN group and PN group at the same time point (P<0.05). Conclusion For elderly patients with gastric cancer undergoing total gastrectomy, glutamine-enhanced nutritional support early after operation is safe and feasible, which can improve nutritional and immune function, promote recovery and reduce duration of hospitalization.

Key words: glutamine, enteral nutrition, total gastrectomy, elderly, clinical application