富含乳清蛋白的围手术期免疫调节饮食可降低胰十二指肠切除术患者血浆IL-6水平：随机对照研究中期分析
乳清水解肽（WHP）是一种从牛奶中提取出的免疫调节物质，具有抗炎及保肝作用。目前关于乳清蛋白在肝胆胰外科手术患者中作用的研究非常有限。
为此，日本国防医学院（防衛医科大学校）和东京大学附属医院（東京大学医学部附属病院）开展了一项前瞻随机对照临床研究，入组2012年12月～2016年8月日本国防医学院外科胰十二指肠切除术患者73例，随机分成2组：WHP组34例在术前5～7d接受正常食物和600mL/d富含WHP的免疫调节饮食（MEIN）；对照组39例接受正常食物和600mL/d对照饮食（MEIBALANCE）。
结果发现，WHP组与对照组相比，术后感染率（41.1%比46.1%）和非感染并发症发生率（47.0%比48.7%）相似，但是术后第1天血浆IL-6水平和术后第3天总胆红素水平显著降低。
因此，在胰十二指肠切除术患者中，富含WHP的免疫调节饮食可以改善手术应激所致炎症反应，有助术后肝功能恢复。
JPEN J Parenter Enteral Nutr. 2017;41(2):274-275.
Perioperative immunomodulating diet containing whey protein reduces plasma il-6 levels in patients undergoing pancreaticoduodenectomy: an interim analysis of a randomized control trial.
Tomoyuki Moriya, Kazuhiko Fukatsu, Suefumi Aosasa, Takuji Noro, Mayumi Hoshikawa, Makoto Nishikawa, Midori Noguchi, Kazuo Hase, Hideki Ueno, Junji Yamamoto.
Surgery, National Defense Medical College, Tokorozawa Saitama, Japan; Surgical Center, The University of Tokyo Hospital, Tokyo, Japan.
PURPOSE: Whey-hydrolyzed peptide (WHP), a major protein complex derived from milk, is widely used clinically for immunomodulating diets (IMD), because WHP-enriched diets have been demonstrated to exert anti-inflammatory effects and protect hepatic function after surgical stress in experimental models. However, there are few reports regarding effects of perioperative WHP-enriched diet administration on patients undergoing hepatobiliary and pancreatic surgeries. We thus performed a prospective randomized control trial to examine the effects of perioperative WHP administration on the postoperative courses of Japanese patients undergoing pancreaticoduodenectomy (PD).
METHODS: This was a prospective, randomized clinical trial conducted at the Department of Surgery, National Defense Medical College. From December 2012 to August 2016, 73 PD patients were enrolled in this clinical study and randomly divided into 2 groups. Thirty-four patients (WHP group) received normal food and 600 mL/d of an IMD (MEIN; Meiji Dairies Co., Tokyo, Japan) for 5-7 days before PD. Thirty-nine patients (control group) received normal food and 600 mL/d of a control diet (MEIBALANCE; Meiji Dairies Co.). The control diet contained the same amounts of energy and protein as the WHP-enriched diet. After surgery, the patients were given their respective diets from postoperative day (POD) 1 to POD7 via the enteral route. The primary end points were the rates of postoperative infectious and noninfectious complications. We also evaluated plasma interleukin-6 (IL-6) levels and biochemical data as secondary end points.
RESULTS: The 2 groups were comparable in terms of preoperative nutrition status, intraoperative blood loss, and operative time. The incidences of infectious (IMD vs Control: 41.1% vs 46.1%) and noninfectious (47.0% vs 48.7%) complications were similar in the 2 groups. However, the plasma IL-6 level on POD 1 and the total bilirubin value on POD3 were significantly decreased in the IMD group as compared with the control group.
CONCLUSIONS: In patients undergoing PD, a WHP-enriched IMD rapidly reduces plasma IL-6 levels and restores hepatic function after surgery, suggesting attenuation of surgical stress.
DOI: 10.1177/0148607116686023