消化系统肿瘤营养治疗的问题及对策
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摘要
消化系统肿瘤的营养治疗在抗肿瘤作用中的重要性远高于其它系统肿瘤,在临床上引起了高度重视。全文就消化系统肿瘤营养治疗中存在的问题,包括评估、治疗、结局、随访以及家庭营养支持等方面,结合国内外研究结果及文献分析进行阐述。提出了消化系统营养治疗应遵循常规、规范、全面、科学的原则,并结合临床指南及专家共识,给肿瘤患者一个合理的个体化营养治疗至关重要。同时也针对消化系统营养支持尚缺乏国内充分的数据及定量评价指标等问题,分析了目前正在进行的一些研究,以期为临床提供更多循证医学依据。
The nutritional therapy of digestive system tumors is more important than other tumors because of its antitumor effect,which has attracted the more attention of experts in clinical practice. In this paper,the nutrition problems in clinical work of digestive system tumor,including evaluation,treatment,outcome,follow-up visit and family nutrition support,are discussed according to data review and literature analysis. It is suggested that the nutrition therapy of digestive cancer should follow the principles of conventional,normative,comprehensive and scientific,and it is essential to provide a reasonable individualized nutrition treatment for cancer patients with clinical guidelines and expert recommendations. At the same time,in order to provide more evidencebased medical basis for clinical practice,there is still lacking in sufficient evidence based medicine data and quantitative evaluation index during cancer nutritional therapy in China.
The nutritional therapy of digestive system tumors is more important than other tumors because of its antitumor effect,which has attracted the more attention of experts in clinical practice. In this paper,the nutrition problems in clinical work of digestive system tumor,including evaluation,treatment,outcome,follow-up visit and family nutrition support,are discussed according to data review and literature analysis. It is suggested that the nutrition therapy of digestive cancer should follow the principles of conventional,normative,comprehensive and scientific,and it is essential to provide a reasonable individualized nutrition treatment for cancer patients with clinical guidelines and expert recommendations. At the same time,in order to provide more evidencebased medical basis for clinical practice,there is still lacking in sufficient evidence based medicine data and quantitative evaluation index during cancer nutritional therapy in China.
引文
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[7] Chinese Society for Parenteral and Enteral Nutrition.Guidelines on nutritional support in patients with tumor.Chinese Society for Parenteral and Enteral Nutrition[J].Zhong Hua Wai Ke Za Zhi,2017,55(11):801-829.
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[17] Wang J,Li Y,Qi Y. Effect of glutamine-enriched nutritional support on intestinal mucosal barrier function,MMP-2,MMP-9 and immune function in patients with advanced gastric cancer during perioperative chemotherapy[J]. Oncol Lett,2017,14(3):3606-3610.
[18] Vidal-Casariego A,Calleja-Fernández A,Ballesteros-Pomar MD,et al. Efficacy of glutamine in the prevention of oral mucositis and acute radiation-induced esophagitis:a retrospective study[J]. Nutr Cancer,2013,65(3):424-429.
[19] Wang X,Pierre JF,Heneghan AF,et al. glutamine improves innate immunity and prevents bacterial enteroinvasion during parenteral nutrition[J]. JPEN J Parenter Enteral Nutr,2015,39(6):688-697.
[20] Zhao Y,Wang C. Effect ofω-3 polyunsaturated fatty acidsupplemented parenteral nutrition on inflammatory and immune function in postoperative patients with gastrointestinal malignancy:a meta-analysis of randomized control trials in China[J]. Medicine(Baltimore),2018,97(16):e0472.
[21] Yu J,Liu L,Zhang Y,et al. Effects of omega-3 fatty acids on patients undergoing surgery for gastrointestinal malignancy:a systematic review and meta-analysis[J]. BMC Cancer,2017,17(1):271.
[22] Klek S,Scislo L,Walewska E,et al. Enriched enteral nutrition may improve short-term survival in stage IV gastric cancerpatients:a randomized,controlled trial[J]. Nutrition,2017,36:46-53.
[23] Chinese Society Oncological Nutrition Supportive Care.Chinese Nutrition Therapy Guidelines for Cancer Patients[M]. Beijing:People’s Medical Publishing House,2015.[中国抗癌协会肿瘤营养与支持治疗委员会.中国肿瘤营养治疗指南[M].北京:人民卫生出版社,2015.]
[24] Donohoe CL,Healy LA,Fanning M,et al. Impact of supplemental home enteral feeding postesophagectomy on nutrition,body composition,quality of life,and patient satisfaction[J]. Dis Esophagus,2017,30(9):1-9.
[25] Murray K,Mehta S. Home parenteral nutrition for patients with intestinal failure due to advanced cancer[J]. Br J Nurs,2018,27(Sup4a):S1-S8.
[26] Liu C,Wang W,Meng X,et al. Albumin/globulin ratio is negatively correlated with PD-1 and CD25 m RNA levels in breast cancer patients[J]. Onco Targets Ther,2018,11:2131-2139.
[27] Chen F,Fang J,Wang H,et al. Effects of nutritional support on short-term clinical outcomes and immune response in unresectable locally advanced oesophageal squamous cell carcinoma[J]. Eur J Cancer Care(Engl),2018,27(2):e12818.
[28] Wang J,Li Y,Qi Y. Effect of glutamine-enriched nutritional support on intestinal mucosal barrier function,MMP-2,MMP-9 and immune function in patients with advanced gastric cancer during perioperative chemotherapy[J]. Oncol Lett,2017,14(3):3606-3610.
[29] Peluso I,Yarla NS,Ambra R,et al. MAPK signalling pathway in cancers:Olive products as cancerpreventive and therapeutic agents[J]. Semin Cancer Biol,2017,pii:S1044-579X(17)30165-7.
[2] Pan H,Cai S,Ji J,et al. The impact of nutritional status,nutritionalrisk,and nutritional treatment on clinical outcome of 2248 hospitalized cancer patients:a multi-center,prospective cohort study in Chinese teaching hospitals[J].Nutr Cancer,2013,65(1):62-70.
[3] Mislang AR,Di Donato S,Hubbard J,et al. Nutritional management of older adults with gastrointestinal cancers:An International Society of Geriatric Oncology(SIOG)review paper[J]. J Geriatr Oncol,2018,9(4):382-392.
[4] Zietarska M,Krawczyk-Lipiec J,Kraj L,et al. chemotherapy-related toxicity,nutritional status and quality of life in precachectic oncologic patients with,or without,high protein nutritional support. a prospective,randomized study[J]. Nutrients,2017,9(10):1108.
[5] Mattox TW. Cancer cachexia:cause,diagnosis,and treatment[J]. Nutr Clin Pract,2017,32(5):599-606.
[6] Arends J,Baracos V,Bertz H,et al. ESPEN expert group recommendations for action against cancer-related malnutrition[J]. Clin Nutr,2017,36(5):1187-1196.
[7] Chinese Society for Parenteral and Enteral Nutrition.Guidelines on nutritional support in patients with tumor.Chinese Society for Parenteral and Enteral Nutrition[J].Zhong Hua Wai Ke Za Zhi,2017,55(11):801-829.
[8] Weimann A,Braga M,Carli F,et al. ESPEN guideline:clinical nutrition in surgery[J]. Clin Nutr,2017,6(3):623-650.
[9] Huhmann MB,August DA. Review of American Society for Parenteral and Enteral Nutrition(ASPEN)clinical guidelines for nutrition support in cancer patients:nutrition screening and assessment[J]. Nutr Clin Pract,2008,23(2):182-188.
[10] Jiang ZM,Chen W,Zhu SN,et al. Investigation on malnutrition(insufficiency),incidence of nutritional risk and application of nutritional support in third-class hospitals of large cities in eastern,central and Western China[J]. Chinese Journal of Clinical Nutrition,2008,1616(6):335-337.[蒋朱明,陈伟,朱赛楠,等.我国东、中、西部大城市三甲医院营养不良(不足)、营养风险发生率及营养支持应用状况调查[J].中国临床营养杂志,2008,16(6):335-337.]
[11] Ye XJ,Ji YB,Ma BW,et al. Comparison of three common nutritional screening tools with the new European Society for Clinical Nutrition and Metabolism(ESPEN)criteria for malnutrition among patients with geriatric gastrointestinal cancer:a prospective study in China[J]. BMJ Open,2018,8(4):e019750.
[12] Abe Vicente M,Bar觔o K,Silva TD,et al. What are the most effective methods for assessment of nutritional status in outpatients with gastric and colorectal cancer?[J]. Nutr Hosp,2013,28(3):585-591.
[13] Bozzetti F,Mariani L,Lo Vullo S,et al. The nutritional risk in oncology:a study of 1,453 cancer outpatients[J].Support Care Cancer,2012,20(8):1919-1928.
[14] Shi HP,Xu HX,Li SY,et al. Five step therapy for malnutrition[J]. Electronic Jourmal of Metabolism and Nutrition of Cancer,2015,2(1):29-33.[石汉平,许红霞,李苏宜,等.营养不良的五阶梯治疗[J].肿瘤代谢与营养电子杂志,2015,2(1):29-33.]
[15] Ponta ML,Rabbione L,BorgioC,et al. Assessing the appropriateness of parenteral nutrition use in hospitalized patients. A comparison on parenteral nutrition bag prescription in different wards and nutritional outcomes[J].Clin Nutr ESPEN,2018,25:87-94.
[16] Kumpf VJ,de Aguilar-Nascimento JE,Diaz-Pizarro Graf JI,et al. American Society for Parenteral and Enteral Nutrition[J]. JPEN J Parenter Enteral Nutr,2017,41(1):104-112.
[17] Wang J,Li Y,Qi Y. Effect of glutamine-enriched nutritional support on intestinal mucosal barrier function,MMP-2,MMP-9 and immune function in patients with advanced gastric cancer during perioperative chemotherapy[J]. Oncol Lett,2017,14(3):3606-3610.
[18] Vidal-Casariego A,Calleja-Fernández A,Ballesteros-Pomar MD,et al. Efficacy of glutamine in the prevention of oral mucositis and acute radiation-induced esophagitis:a retrospective study[J]. Nutr Cancer,2013,65(3):424-429.
[19] Wang X,Pierre JF,Heneghan AF,et al. glutamine improves innate immunity and prevents bacterial enteroinvasion during parenteral nutrition[J]. JPEN J Parenter Enteral Nutr,2015,39(6):688-697.
[20] Zhao Y,Wang C. Effect ofω-3 polyunsaturated fatty acidsupplemented parenteral nutrition on inflammatory and immune function in postoperative patients with gastrointestinal malignancy:a meta-analysis of randomized control trials in China[J]. Medicine(Baltimore),2018,97(16):e0472.
[21] Yu J,Liu L,Zhang Y,et al. Effects of omega-3 fatty acids on patients undergoing surgery for gastrointestinal malignancy:a systematic review and meta-analysis[J]. BMC Cancer,2017,17(1):271.
[22] Klek S,Scislo L,Walewska E,et al. Enriched enteral nutrition may improve short-term survival in stage IV gastric cancerpatients:a randomized,controlled trial[J]. Nutrition,2017,36:46-53.
[23] Chinese Society Oncological Nutrition Supportive Care.Chinese Nutrition Therapy Guidelines for Cancer Patients[M]. Beijing:People’s Medical Publishing House,2015.[中国抗癌协会肿瘤营养与支持治疗委员会.中国肿瘤营养治疗指南[M].北京:人民卫生出版社,2015.]
[24] Donohoe CL,Healy LA,Fanning M,et al. Impact of supplemental home enteral feeding postesophagectomy on nutrition,body composition,quality of life,and patient satisfaction[J]. Dis Esophagus,2017,30(9):1-9.
[25] Murray K,Mehta S. Home parenteral nutrition for patients with intestinal failure due to advanced cancer[J]. Br J Nurs,2018,27(Sup4a):S1-S8.
[26] Liu C,Wang W,Meng X,et al. Albumin/globulin ratio is negatively correlated with PD-1 and CD25 m RNA levels in breast cancer patients[J]. Onco Targets Ther,2018,11:2131-2139.
[27] Chen F,Fang J,Wang H,et al. Effects of nutritional support on short-term clinical outcomes and immune response in unresectable locally advanced oesophageal squamous cell carcinoma[J]. Eur J Cancer Care(Engl),2018,27(2):e12818.
[28] Wang J,Li Y,Qi Y. Effect of glutamine-enriched nutritional support on intestinal mucosal barrier function,MMP-2,MMP-9 and immune function in patients with advanced gastric cancer during perioperative chemotherapy[J]. Oncol Lett,2017,14(3):3606-3610.
[29] Peluso I,Yarla NS,Ambra R,et al. MAPK signalling pathway in cancers:Olive products as cancerpreventive and therapeutic agents[J]. Semin Cancer Biol,2017,pii:S1044-579X(17)30165-7.