Effects of structured triglyceride on postoperative recovery of patients with primary liver cancer after hepatectomy: a prospective study / 中华消化外科杂志

ABSTRACT

Objective To investigate the effects of structured triglyceride on hepatic function,nutritional status,inflammatory reaction and immunologic function of patients with primary liver cancer after hepatectomy.Methods A prospective,double-blind,randomized,controlled clinical trial was conducted based on the clinical data of 80 patients with primary liver cancer who underwent hepatectomy at the Drum Tower Hospital from January 2011 to December 2012.All the 80 patients were allocated into the testing group (40 patients) and the control group (40 patients) based on a random number table,and received isometrical nitrogen and isocaloric parenteral nutritional support therapy for 7 days after operation.Structured triglyceride (STG) and physical mixed medium chain/long chain triglycerides (MCT/LCT) were applied to the patients in the testing group and the control group,respectively.The hepatic function,nutritional status,inflammatory reaction,immunologic function and prognosis of patients were compared between the 2 groups.The measurement data with normal distribution were presented as (x) ± s.The comparision between groups was evaluated with an independent sample t test.The trend analyses for variables were done using the repeated measures ANOVA.The measurement data with skew distribution were described as M(P25,P75) and analyzed by the analysis of variance.The count data were analyzed using the chi-square test.Results All the 80 patients who were screened for eligibility were randomly divided into the testing group (40 patients) and the control group (40 patients).The alanine transaminase (ALT),aspartate transaminase (AST),prealbumin,choline esterase,C-reactive protein,IgG,IgM,IgA,CD3 +,CD4 +,CD8 + and CD4 +/CD8 + in the 2 groups showed a range of variations before operation and at postoperative day 5 and 7.The ALT,AST,prealbumin,choline esterase,C-reactive protein,IgG,IgM,IgA,CD3 +,CD4 +,CD8 + and CD4+/CD8 + from preoperation to postoperative day 7 were from (36 ± 10)U/L,(37 ± 13)U/L,(233 ±42)mg/L,(154±32)U/L,(8.1 ±1.6)mg/L,(14±5)g/L,(3.2±1.3)g/L,(2.1 ±1.3)g/L,55.6％±6.8％,37.5％±2.0％,25.9％±2.9％ and 1.5 ±0.5 to (83 ±33)U/L,(63 ±42)U/L,(208 ±37)mg/L,(145 ±26)U/L,(30.3 ±8.6)mg/L,(12 ±3)g/L,(2.8 ±1.6)g/L,(2.0 ±1.2)g/L,46.2％±3.9％,33.4％±3.1％,27.9％±3.0％ and 1.2 ±0.4 in the control group,and from (36 ± 12)U/L,(36 ± 14)U/L,(231 ±45)mg/L,(149 ±25)U/L,(7.6 ± 1.8)mg/L,(13 ±5)g/L,(3.3 ±0.7)g/L,(2.1 ± 1.1)g/L,54.2％±6.3％,37.6％±3.5％,24.8％±3.4％ and 1.5 ±0.4 to (43 ±30)U/L,(40 ±33)U/L,(255 ±44)mg/L,(153 ±27)U/L,(21.7 ±11.2)mg/L,(17 ±4)g/L,(4.1 ± 1.7)g/L,(2.4 ± 1.9)g/L,57.9％±3.2％,39.2％ ± 2.9％ 22.7％ ± 3.4％ and 1.7 ± 0.4 in the testing group,respectively,showing significant differences between the 2 groups (F =94.71,86.40,64.22,16.77,8.18,37.23,11.52,22.58,50.30,26.44,13.16,44.84,P ＜ 0.05).There were no significant differences in the level of ALT,AST,prealbumin,choline esterase,C-reactive protein,IgA,CD8 + and CD4 +/CD8 + at postoperative day 5 between the 2 groups (t =1.24,1.03,0.91,1.02,0.53,0.68,1.61,0.98,P＞0.05).There were significant differences in the IgG,IgM,CD3+and CD4 + at postoperative day 5 between the 2 groups (t =2.58,3.15,3.87,2.46,P ＜ 0.05).There were significant differences in the levels of ALT,AST,prealbumin,choline esterase,C-reactive protein,IgG,IgM,IgA,CD3 +,CD4 +,CD8 + and CD4 +/CD8 + at postoperative day 7 between the 2 groups (t =4.83,2.79,5.58,2.12,3.10,2.53,4.17,2.35,3.45,2.98,3.12,3.75,P ＜0.05).The body weight of patients at postoperative day 7 and duration of hospital stay in the control group were (57 ± 6) kg and (9.9 ± 1.5) days,which were significantly different from (61 ± 8) kg and (8.8 ± 1.3) days in the testing group (t =3.67,2.71,P ＜ 0.05).Conclusion Structured triglyceride can effectively improve the recovery of hepatic function,nutrition status and immunologic function and reduce inflammatory reaction for the patients with primary liver cancer after hepatectomy.