Wuhan Central Hospital Research Articles

Application of arginine-rich enteral nutritional support therapy after gastrectomy

Objective To explore the clinical effects of arginine-rich enteral nutritional support therapy in patients undergoing gastrectomy. Methods The clinical data of 84 patients with gastric carcinoma who were admitted to the Wuhan Central Hospital from January 2013 to December 2014 were retrospectively analyzed. After gastrectomy, 42 patients undergoing arginine-rich enteral nutritional support therapy were allocated to the argininerich enteral nutrition (AEN) group and 42 patients undergoing standardized enteral nutritional support therapy were allocated to the enteral nutrition (EN) group. The indexes of nutrition [BMI of patients were calculated and serum total protein (TP) , albumin (Alb) and prealbumin (PAB) were detected] and immunology [T-lymphocyte subsets, total number of lymphocyte, white blood cell (WBC) and CD4+/CD8+ were detected by flow cytometry] , postoperative complications and indexes of prognosis were analyzed. The measurment data with normal distribution were presented as±s. The comparision between groups were evaluated with thet test and repeated measures ANOVA. The count data were analyzed using the chi-square test. Results The value of TP from preoperation to postoperative day 7 was from (64 ± 16) g/ L to (55 ± 13) g/ L in the AEN group and from (65 ±21) g/ L to (52 ± 11) g/ L in the EN group, with no significant difference between the 2 groups (F =29.653, P >0.05) . The values of Alb and PAB from pre-operation to postoperative day 7 were from (33 ± 17) g/ L to (32 ± 3) g/ L and from (0.20 ±0.01) g/ L to (0.26 ±0.06) g/ L in the AEN group and from (32 ±19) g/ L to (27 ± 5) g/ L and from (0.20 ±0.03) g/ L to (0.22 ± 0.03) g/ L in the EN group, respectively, with significant differences in the Alb and PAB between the 2 groups (F =21.784, 10.653, P 0.05) . The percentages of CD4+T-cell and CD4+ /CD8+ before operation and at postoperative day 10 were 34. 7% ± 5. 4% , 39.5% ± 3. 9% and 1.80 ± 0.29, 2.23 ± 0.32 in the AEN group, and 33. 2%±4. 6% , 34. 6%±2. 4% and 1. 73 ±0. 26, 1. 82 ±0.42 in the EN group, respectively, with no significant difference in the above indexes between the 2 groups (F =14.398, 7.473, P 0.05) . There was no perioperative death. The hospital expenses were (17 000 ±4 000) yuan in the AEN group and (22 000 ± 5 000) yuan in the EN group, with a significant difference between the 2 groups (t =3.860, P <0.05) . Conclusion Arginine-rich enteral nutritional support therapy is superior to standardized enteral nutrition in effectively improving postoperative nutrition status, immune function and prognosis of patients undergoing gastrectomy. Key words: Gastric neoplasms; Nutritional support therapy, enteral

Prognostic significance of urokinase-type plasminogen activator and its receptor in patients with systemic inflammatory response syndrome.

This study aimed to determine the plasma levels of urokinase-type plasminogen activator (uPA), urokinase-type plasminogen activator receptor (uPAR), D-dimer, IL-6 and TNF-α and observe the relations among uPA, uPAR, D-dimer, IL-6 and TNF-α in patients with systemic inflammatory response syndrome (SIRS). A prospective, clinical case-control study was conducted in patients with SIRS at age of more than 55 years old treated during 2008-2010 at Wuhan Central Hospital. Venous blood samples were collected by routine venipuncture. Eighty-five patients were divided into two groups according to diagnostic criteria of SIRS: SIRS patients from intensive care units (n=50), and non-SIRS patients from medical wards (n=35). Thirty healthy blood donors who visited the General Health Check-up Division at Wuhan Central Hospital served as controls. Excluded from the study were (1) those patients with pregnancy; (2) those with cancer; (3) those died after admission into the ICU in 7 days; (4) those received cardiopulmonary resuscitation; (5) those who had previous blood system diseases; and (6) those with SIRS before admission into the ICU. The levels of uPA, uPAR, D-D, IL-6 and TNF-α in blood were detected by commercial enzyme-linked immunosorbent assay (ELISA) kit. The data were analyzed using SPSS version 17.0 and expressed as mean ± standard. Student's t test and the Mann-Whitney U test were used in the analysis. The relations of uPA, uPAR and D-dimer, IL-6 TNF-α levels were analyzed using Spearman's rank-order correlation coefficient test. The plasma levels of uPA, uPAR, D-dimer,IL-6 and TNF-α in the patients with SIRS were obviously higher than those in the non-SIRS patients and controls (P<0.001). Correlation analysis showed a positive correlation between uPAR and IL-6 levels (r=0.395, P=0.004) and between uPAR and TNF-α levels (r=0.606, P<0.001), but no correlation between uPAR and D-dimer levels (r=0.069, P=0.632). No correlation was observed between uPA, D-dimer, IL-6 and TNF-α levels (P>0.05). The establishment of ROC curve was based on the levels of uPAR, D-dimer, IL-6 and TNF-α in 24 hours for the diagnosis of multiple organ dysfunction syndrome (MODS), and the ROC areas under the curve were 0.76, 0.58, 0.86 and 0.83, respectively. uPA and uPAR play a major role in patients with SIRS in the process of coagulation disorder, but the mechanism of SIRS is not the same. uPAR may play a central role in the development of SIRS to MODS.