肠外营养支持下胃肠道肿瘤患者围术期甲状腺激素及前清蛋白水平变化及意义

摘要

目的 探讨肠外营养支持下胃肠道肿瘤患者围术期甲状腺激素(TH)及前清蛋白(PA)水平变化及临床意义.方法 行根治术的胃肠道肿瘤患者30例为肿瘤组.同期我院收入院的无甲状腺疾病的患者20例为对照组.对照组于术前,肿瘤组于术前1 d及术后第1、3、5、8天分别检测血清TH及PA水平.肿瘤组于术后给予15～20 kcal·kg-1·d-1的肠外营养支持5～7 d.用微粒子捕捉酶免疫分析法检测血清游离三碘甲状腺原氨酸(FT3)、总三碘甲状腺原氨酸(TT3)、游离甲状腺素(FT4)及促甲状腺激素(TSH)水平,荧光偏振免疫分析法检测血清总甲状腺素(TT4)水平,放射免疫分析法检测血清反三碘甲状腺原氨酸(rT3)、PA水平.结果 肿瘤患者术前1 d及术后第1、3、5、8天的FT3、TT3、rT3水平比较,差异均有统计学意义(P＜0.01).其中,术后第8天分别与术前1 d、术后第5天的FT3、TT3、rT3水平比较,差异均有统计学意义(P＜0.05).术后第1、5、8天血清PA与FT3均呈正相关(P＜0.01),术后第3、5、8天血清PA与rT3均呈负相关(P＜0.01).结论 胃肠道肿瘤患者术前已存在非甲状腺疾病综合征(NTIS);胃肠道肿瘤患者术后NTIS短期内很难完全恢复;FT3、rT3可作为胃肠道肿瘤患者围术期代谢状态和营养状态的客观指标.%Objective To discuss the changes and clinical significance of thyroid hormone ( TH ) and prealbumin ( PA ) in treating gastroenteric tumor patients with parenteral nutrition support during peri - operative periods. Materials and Methods Dynamically monitor TH and prealbumin concentration of 30 gastroenteric tumor patients and 20 control subjects without Thyroid disease before operation and on the 1 st, 3rd, 5th, 8th days after operation. Correlation analysis was made between TH and prealbumin. The gastroenteric tumor patients mentioned above were supported by parenteral nutrition (15 ~20kcal ? Kg~ ? D-1 ). FT3、 TT3、 FT4、 TSH were detected by microparticle enzyme immunoassay ( MEIA ), TT4 were tested by fluorescence polarization immunoassay ( FPIA ), Rt3 and prealbumin ( PA ) were detected by immunoturbidimetric assay. Results In terms of the FT3、TT3、 Rt3 level of Tumor patients Id before surgery and on thelst, 3rd, 5th, 8th after surgery, the differences were statistically significant ( P <0. 01, see table 2 ), among which, the FT3、 TT3、 Rt3 level on the 8th day after surgery was statistically significantly different with the results of Id before surgery and the 5th day after surgery ( P <0. 05 ). A clearly positive correlation was observed between FT3 and PA level of thelst, 5th, 8th days after operation ( P <0. 01 ). Meanwhile, there was a negative correlation between Rt3 and PA of the 3rd, 5th, 8th days after operation ( P <0. 01 ). Conclusion NTIS existed before the operation on gastroenteric tumor patients. There was a slim chance for patients to completely recover from NTIS in a short period after the operation. FT3 and Rt3 could be referred as an objective index for the assessment of metabolism and nutrition situation.