加味养阴清肺汤联合营养干预对鼻咽癌放疗患者营养状态及疗效的影响
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摘要
目的探讨加味养阴清肺汤联合营养干预对鼻咽癌放疗患者营养状态及疗效的影响。方法将120例接受放射治疗的鼻咽癌初治患者,随机分为加味养阴清肺汤联合营养干预组(A组)、加味养阴清肺汤组(B组)、营养干预组(C组)和单纯放疗组(D组),每组各30例,各组患者均观察11～13周,(1)检测四组患者放疗前、中、后的生化指标;(2)观察四组患者放疗前、中、后期营养不良发生率和程度;(3)评价四组患者放疗结束时和放疗结束后1月的疗效。结果 (1)治疗中及治疗后四组患者的ALB、PAB、TRF、LC平均水平差异均有统计学意义(P<0.05);(2)放疗中(DT=40 Gy)和放疗后(DT=70 Gy)四组患者的Ⅰ、Ⅱ、Ⅲ和Ⅳ度营养不良发生率差异均有统计学意义(均P<0.05);(3)四组患者疾病缓解率的差异在放疗结束后1月时差异有统计学意义(96.67%vs. 93.33%vs. 93.33%vs. 89.66%,均P<0.05)。结论加味养阴清肺汤联合营养干预能更好的改善患者营养状况和生化指标,保证放疗进度和疗效。
Objective To investigate the effect of modified Yangyin Qingfei decoction combined with nutritional intervention on the nutritional status and the efficacy of nasopharyngeal carcinoma patients treated with radiotherapy. Methods A total of 120 patients with nasopharyngeal carcinoma who received radiotherapy were randomly divided into four groups: modified Yangyin Qingfei decoction combined with nutritional intervention group(group A, n=30), modified Yangyin Qingfei decoction group(group B, n=30), intervention group(group C, n=30) and radiotherapy group(group D, n=30). All groups were observed for 11-13 weeks.(1) The biochemical indexes of four groups before, during(DT=40 Gy) and after(DT=70 Gy) radiotherapy were detected;(2) The incidence and degree of malnutrition were observed at the three time points above;(3) The therapeutic effects of four groups at the end of radiotherapy and one month after radiotherapy were evaluated. Results(1) There were significant differences in the average levels of ALB, PAB, TRF, LC at DT=40 Gy and 70 Gy among four groups(P<0.05);(2) There were significant differences in the incidence of malnutrition at DT=40 Gy and 70 Gy among four groups(P<0.05);(3) There was statistical significance in disease remission rate among four groups at one month after radiotherapy(96.67% vs. 93.33% vs. 93.33% vs. 89.66%, all P<0.01). Conclusion Modified Yangyin Qingfei decoction combined with nutritional intervention could improve the nutritional status and biochemical indexes of nasopharyngeal carcinoma patients receiving radiotherapy, and ensure the progress and efficacy of radiotherapy.
Objective To investigate the effect of modified Yangyin Qingfei decoction combined with nutritional intervention on the nutritional status and the efficacy of nasopharyngeal carcinoma patients treated with radiotherapy. Methods A total of 120 patients with nasopharyngeal carcinoma who received radiotherapy were randomly divided into four groups: modified Yangyin Qingfei decoction combined with nutritional intervention group(group A, n=30), modified Yangyin Qingfei decoction group(group B, n=30), intervention group(group C, n=30) and radiotherapy group(group D, n=30). All groups were observed for 11-13 weeks.(1) The biochemical indexes of four groups before, during(DT=40 Gy) and after(DT=70 Gy) radiotherapy were detected;(2) The incidence and degree of malnutrition were observed at the three time points above;(3) The therapeutic effects of four groups at the end of radiotherapy and one month after radiotherapy were evaluated. Results(1) There were significant differences in the average levels of ALB, PAB, TRF, LC at DT=40 Gy and 70 Gy among four groups(P<0.05);(2) There were significant differences in the incidence of malnutrition at DT=40 Gy and 70 Gy among four groups(P<0.05);(3) There was statistical significance in disease remission rate among four groups at one month after radiotherapy(96.67% vs. 93.33% vs. 93.33% vs. 89.66%, all P<0.01). Conclusion Modified Yangyin Qingfei decoction combined with nutritional intervention could improve the nutritional status and biochemical indexes of nasopharyngeal carcinoma patients receiving radiotherapy, and ensure the progress and efficacy of radiotherapy.
引文
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[9]舒晓亮,康凯,于婷婷,等.营养支持对营养不良的外科病人的影响的meta分析[A].中华医学会肠外肠内营养学分会全国肠外肠内营养学术大会,2014,297.[Shu XL,Kang K,Yu TT,et al.Meta analysis of the effect of nutritional support on surgical patients with malnutrition[A].The Chinese Academy of Medicine's Parenteral and Enteral Nutrition Branch:National Conference on Parenteral and Enteral Nutrition,2014,297.]
[10]Kuzuya M.Evidence supporting nutritional interventions for the elderly[J].Nihon Ronen Lgakkai Zasshi,2013,50(5):627-8.
[11]Beijer E,Schoenmakers J,Vijgen G,et al.A role of active brown adipose tissue in cancer cachexia?[J].Oncol Rev,2012,6(1):e11.
[12]Pergialiotis V,Doumouchtsis SK,Perrea D,et al.The Impact of Underweight Status on the Prognosis of Ovarian Cancer Patients:A Meta-Analysis[J].Nutr Cancer,2016,68(6):918-25.
[13]区晓敏,史琪,周鑫,等.鼻咽癌IMRT远期疗效和不良反应分析[J].中华放射肿瘤学杂志,2016,25(4):304-9.[Qu XM,Shi Q,Zhou X,et al.Long-term efficacy and adverse effects of intensitymodulated radiotherapy for nasopharyngeal carcinoma[J].Zhonghua Fang She Zhong Liu Xue Za Zhi,2016,25(4):304-9.]
[14]沈红梅,贾立群,黄杰,等.加味养阴清肺汤防治急性放射性口腔炎的临床观察[J].辽宁中医杂志,2012,39(6):1076-9.[Shen HM,Jia LQ,Huang J,et al.Clinical Observation on Treatment of Acute Radiation-Induced Stomatitis by Modified Yangyin Qingfei Decoction[J].Liaoning Zhong Yi Za Zhi,2012,39(6):1076-9.]
[2]Bossola M.Nutritional Interventions in head and neck cancer patients undergoing chemoradiotherapy:A narrative review[J].Nutrients,2015,7(1):265-76.
[3]陈东,沈丽娜.加味养阴清肺汤治疗鼻咽癌放射性口腔炎临床观察[J].浙江中医杂志,2016,51(9):649.[Chen D,Shen LN.Clinical observation on the treatment of nasopharyngeal carcinoma with radioactive stomatitis by Jiawei Yangyin Qingfei Decoction[J].Zhejiang Zhong Yi Za Zhi,2016,51(9):649.]
[4]汤钊猷.现代肿瘤学[M].上海:复旦大学出版社,2011:764-5.[Tang zhaoyou.Modern Oncology[M].Shanghai:Fudan University Press,2011:764-5.]
[5]Hu WH,Cajas-Monson LC,Eisenstein S,et al.Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer:an analysis of ACS-NSQIP[J].Nutr J,2015,14:91.
[6]Boscolo-Rizzo P,Tirelli G,Mantovani M,et al.Non-endemic locoregionally advanced nasopharyngeal carcinoma:long-term outcome after induction plus concurrent chemoradiotherapy in everyday clinical practice[J].Eur Arch Otorhinol,2015,272(11):3491-8.
[7]高天生,范小玲,李庚,等.吉西他滨联合奈达铂化疗后序贯行姑息性放疗治疗复发性鼻咽癌的临床疗效分析[J].临床合理用药杂志,2015,24:38-40.[Gao TS,Fan XL,Li G,et al.Clinical analysis of palliative radiotherapy for recurrent nasopharyngeal carcinoma after gemcitabine combined with nedaplatin chemotherapy[J].Lin Chuang He Li Yong Yao Za Zhi,2015,24:38-40.]
[8]张海荣,洪金省,苏丽,等.鼻咽癌患者放疗期间营养指数模型构建及营养状况下降影响因素分析[J].中国卫生统计,2015,32(6):959-62.[Zhang HR,Hong JS,Su L,et al.Construction of Nutrition Index Model and Analysis of the Influencing Factors for the Declinein Nutritional Status in Patients with Nasopharyngeal Carcinoma during Radiotherapy[J].Zhongguo Wei Sheng Tong Ji,2015,32(6):959-62.]
[9]舒晓亮,康凯,于婷婷,等.营养支持对营养不良的外科病人的影响的meta分析[A].中华医学会肠外肠内营养学分会全国肠外肠内营养学术大会,2014,297.[Shu XL,Kang K,Yu TT,et al.Meta analysis of the effect of nutritional support on surgical patients with malnutrition[A].The Chinese Academy of Medicine's Parenteral and Enteral Nutrition Branch:National Conference on Parenteral and Enteral Nutrition,2014,297.]
[10]Kuzuya M.Evidence supporting nutritional interventions for the elderly[J].Nihon Ronen Lgakkai Zasshi,2013,50(5):627-8.
[11]Beijer E,Schoenmakers J,Vijgen G,et al.A role of active brown adipose tissue in cancer cachexia?[J].Oncol Rev,2012,6(1):e11.
[12]Pergialiotis V,Doumouchtsis SK,Perrea D,et al.The Impact of Underweight Status on the Prognosis of Ovarian Cancer Patients:A Meta-Analysis[J].Nutr Cancer,2016,68(6):918-25.
[13]区晓敏,史琪,周鑫,等.鼻咽癌IMRT远期疗效和不良反应分析[J].中华放射肿瘤学杂志,2016,25(4):304-9.[Qu XM,Shi Q,Zhou X,et al.Long-term efficacy and adverse effects of intensitymodulated radiotherapy for nasopharyngeal carcinoma[J].Zhonghua Fang She Zhong Liu Xue Za Zhi,2016,25(4):304-9.]
[14]沈红梅,贾立群,黄杰,等.加味养阴清肺汤防治急性放射性口腔炎的临床观察[J].辽宁中医杂志,2012,39(6):1076-9.[Shen HM,Jia LQ,Huang J,et al.Clinical Observation on Treatment of Acute Radiation-Induced Stomatitis by Modified Yangyin Qingfei Decoction[J].Liaoning Zhong Yi Za Zhi,2012,39(6):1076-9.]