早期肠内营养干预对晚期食管癌同步放化疗患者肠黏膜屏障功能及营养状况的影响
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摘要
目的探讨早期肠内营养干预对晚期食管癌同步放化疗患者肠黏膜屏障功能及营养状态的影响.方法选择2015-07/2016-10收治的晚期食管癌同步放化疗患者92例为研究对象,采用前瞻性研究的方法随机分为干预组和对照组各46例.对照组给予常规饮食或静脉营养支持,干预组给予早期肠内营养支持.治疗后1 mo,比较两组患者肠黏膜屏障功能、血清营养学指标、近期疗效.结果干预组患者血清内毒素、二胺氧化酶、D-乳酸含量明显低于对照组(10.24±2.12EU/L vs15.45±3.21 EU/L, 5.65±0.82 U/L vs8.05±1.35 U/L, 0.29±0.07μmol/L vs 0.35±0.08μmol/L)(t=9.186, 10.306,3.828, P <0.05, P <0.01);血清白蛋白、前白蛋白、转铁蛋白含量明显高于对照组(32.41±4.35 g/L vs 28.45±4.32 g/L, 0.26±0.0 g/L vs0.19±0.06 g/L, 1.82±0.36 vs1.45±0.32)(t=4.381, 4.748, 5.210, P <0.05);晚期食管癌患者缓解率、控制率均明显高于对照组(80.43%vs60.87%, 91.30%vs76.09%)(χ~2=4.246, 3.903, P <0.05).结论早期肠内营养支持有助于提高晚期食管癌同步放化疗患者近期疗效,可能与保护患者肠黏膜屏障功能、改善营养状况有关.
AIM To evaluate the effect of early enteral nutrition on intestinal mucosal barrier and nutrition status in advanced esophageal cancer patients undergoing synchronous chemoradiotherapy. METHODS Ninety-two advanced esophageal cancer patients undergoing synchronous chemoradiotherapy from July 2015 to October 2016 were divided into an intervention group and a control group. The control group was given routine diet or intravenous nutrition support, and the intervention group was given early enteral nutrition support. One month after treatment, intestinal mucosal barrier, serum nutrition indexes, and short-term efficacy were compared between the two groups. RESULTS Serum endotoxin, diamine oxidase, and D-lactic acid were significantly lower in the intervention group than in the control group(10.24 ± 2.12 EU/L vs 15.45 ± 3.21 EU/L, 5.65 ± 0.82 U/L vs 8.05 ± 1.35 U/L, 0.29 ± 0.07 μmol/L vs 0.35 ± 0.08 μmol/L; t = 9.186, 10.306, 3.828; P < 0.05 or 0.01). Serum albumin, prealbumin, and transferrin were significantly higher in the intervention group than in the control group(32.41 ± 4.35 g/L vs 28.45 ± 4.32 g/L, 0.26 ± 0.0 g/L vs 0.19 ± 0.06 g/L, 1.82 ± 0.36 vs 1.45 ± 0.32; t = 4.381, 4.748, 5.210; P < 0.05). Remission rate and control rate were significantly higher in the intervention group than in the control group(80.43% vs 60.87%, 91.30% vs 76.09%; χ~2 = 4.246, 3.903; P < 0.05).CONCLUSION Early enteral nutrition support can help improve the short-term efficacy in advanced esophageal cancer patients undergoing synchronous chemoradiotherapy,which may be related to protecting intestinal mucosal barrier function and improving the nutritional status.
AIM To evaluate the effect of early enteral nutrition on intestinal mucosal barrier and nutrition status in advanced esophageal cancer patients undergoing synchronous chemoradiotherapy. METHODS Ninety-two advanced esophageal cancer patients undergoing synchronous chemoradiotherapy from July 2015 to October 2016 were divided into an intervention group and a control group. The control group was given routine diet or intravenous nutrition support, and the intervention group was given early enteral nutrition support. One month after treatment, intestinal mucosal barrier, serum nutrition indexes, and short-term efficacy were compared between the two groups. RESULTS Serum endotoxin, diamine oxidase, and D-lactic acid were significantly lower in the intervention group than in the control group(10.24 ± 2.12 EU/L vs 15.45 ± 3.21 EU/L, 5.65 ± 0.82 U/L vs 8.05 ± 1.35 U/L, 0.29 ± 0.07 μmol/L vs 0.35 ± 0.08 μmol/L; t = 9.186, 10.306, 3.828; P < 0.05 or 0.01). Serum albumin, prealbumin, and transferrin were significantly higher in the intervention group than in the control group(32.41 ± 4.35 g/L vs 28.45 ± 4.32 g/L, 0.26 ± 0.0 g/L vs 0.19 ± 0.06 g/L, 1.82 ± 0.36 vs 1.45 ± 0.32; t = 4.381, 4.748, 5.210; P < 0.05). Remission rate and control rate were significantly higher in the intervention group than in the control group(80.43% vs 60.87%, 91.30% vs 76.09%; χ~2 = 4.246, 3.903; P < 0.05).CONCLUSION Early enteral nutrition support can help improve the short-term efficacy in advanced esophageal cancer patients undergoing synchronous chemoradiotherapy,which may be related to protecting intestinal mucosal barrier function and improving the nutritional status.
引文
1兰蓝,赵飞,蔡玥,武瑞仙,孟群.中国居民2015年恶性肿瘤死亡率流行病学特征分析.中华流行病学杂志2018;39:32-34[DOI:10.3760/cma.j.issn.0254-6450.2018.01-006]
2李德育,陈喜军,郑建萍,钟江鸣,郑艳,刘振华,崔同建.不同肠内营养对结肠癌化疗患者肠黏膜屏障保护作用的影响.慢性病学杂志2016;17:1091-1094[DOI:10.16440/j.cnki.1674-8166.2016.10.007]
3 Clavier JB,Antoni D,Atlani D,Ben Abdelghani M,Schumacher C,Dufour P,Kurtz JE,Noel G.Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer.Dis Esophagus2014;27:560-567[PMID:23106980 DOI:10.1111/j.1442-2050.2012.01441.x]
4吕家华,李涛,朱广迎,李杰,赵二,祝淑钗,邢力刚,杨道科,谢丛华,申良方,张海霖,石安辉,王菁,潘闻燕,李昉,王奇峰,郎锦义,石汉平.肠内营养对食管癌同步放化疗患者营养状况、不良反应和近期疗效的影响-前瞻性、多中心、随访对照临床研究(NCT02399306).中华放射肿瘤学杂志2018;27:44-48[DOI:10.3760/cma.j.issn.1004-4221.2018.01.009]
5吕家华,李涛,谢丛华,李杰,邢力刚,张晓智,申良方,赵快乐,赵仁,杨道科,李霞,祝淑钗,孙伟,石汉平.食管癌放疗患者肠内营养专家共识.肿瘤代谢与营养电子杂志2015;2:29-32
6 Eisenhauer EA,Therasse P,Bogaerts J,Schwartz LH,Sargent D,Ford R,Dancey J,Arbuck S,Gwyther S,Mooney M,Rubinstein L,Shankar L,Dodd L,Kaplan R,Lacombe D,Verweij J.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1).Eur J Cancer 2009;45:228-247[PMID:19097774 DOI:10.1016/j.ejca.2008.10.026]
7 Mak M,Bell K,Ng W,Lee M.Nutritional status,management and clinical outcomes in patients with esophageal and gastrooesophageal cancers:A descriptive study.Nutr Diet 2017;74:229-235[PMID:28731604 DOI:10.1111/1747-0080.12306]
8徐桂琼,李民英,雷风,叶奕菁,白玉海,欧阳玉秀,周嘉雄.经鼻肠管肠内营养支持在食管癌放疗患者中的应用.中国基层医药2017;24:228-231[DOI:10.3760/cma.j.issn.1008-6706.2017.02.018]
9 Li HC,Fan XJ,Chen YF,Tu JM,Pan LY,Chen T,Yin PH,Peng W,Feng DX.Early prediction of intestinal mucosal barrier function impairment by elevated serum procalcitonin in rats with severe acute pancreatitis.Panceatology 2016;16:211-217[DOI:10.1016/j.pan.2015.12.177]
10苏赛赛,鲍丽莎.大黄通便颗粒联合早期肠内营养治疗下急性胰腺炎的临床疗效及对肠道黏膜屏障功能的影响.世界华人消化杂志2016;24:2720-2725[DOI:10.11569/wcjd.v24.i17.2720]
11姜雯雯,杨大刚,孙晓红,王惠群.早期肠内营养对食管癌患者放化疗后营养状况及胰岛素抵抗的影响.国际老年医学杂志2016;37:216-219;231[DOI:10.3969/j.issn.1674-7593.2016.05.007]
12王舜尧,柴滨.谷氨酰胺联合膳食纤维强化肠内营养对重症医学科患者的支持效果.世界华人消化杂志2014;22:2626-2631[DOI:10.11569/wcjd.v22.i18.2626]
13 Takesue T,Takeuchi H,Ogura M.Erratum to:A prospective randomized trial of enteral nutrition after troracoscopic esophagectomy for esophageal cancer.Ann Surg Oncol 2016;23:1060-1061[DOI:10.1245/s10434-016-5480-0]
14虞桂平,陈国强,黄斌.老年食管癌患者术后早期肠内营养对营养状况及免疫功能的影响.中华胸心血管外科杂志2016;32:569-573[DOI:10.3760/cma.j.issn.1001-4497.2016.09.017]
15王倩,王军,王祎,景绍武,刘青,曹峰,焦文鹏,杨从容,程云杰,武亚晶.营养状况与炎症指标对食管癌同期放化疗急性不良反应的影响.中华放射肿瘤学杂志2017;26:1012-1018[DOI:10.3760/cma.j.issn.1004-4221.2017.09.007]
16赵桂彬,曹守强,张凯,辛衍忠,韩敬泉,董庆,崔键.早期肠内营养对食管癌患者术后免疫功能和临床结局的影响.中华胃肠外科杂志2014;17:356-360[DOI:10.3760/cma.j.issn.1671-0274.2014.04.014]
17 Zhang Z,Li H.Yan C,Xu C,Hu R,Ma M,Wei H,Meng Y.A comparative study on the efficacy of fast-track surgery in the treatment of esophageal cancer patients combined with metabolic syndrome.Oncol Lett 2017;14:4812-4816[DOI:10.3892/ol.2017.6759]
18 Chan KT,Choi MY,Lai KK,Tan W,Tung LN,Lam HY,Tong DK,Lee NP,Law S.Overexpression of transferrin receptor CD71 and its tumorigenic properties in esophageal squamous cell carcinoma.Oncol Rep 2014;31:1296-1304[PMID:24435655DOI:10.3892/or.2014.2981]
19 Peng J,Cai J,Niu ZX,Chen LQ.Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy:a meta-analysis.Dis Esophagus2016;29:333-341[PMID:25721689 DOI:10.1111/dote.12337]
20李宁,高岭,孟丹丹,弋振营,张红蕊,徐志巧.营养治疗在晚期食管癌同步放化疗过程中早期介入的作用研究.癌症进展2018;16:963-966[DOI:10.11877/j.issn.1672-1535.2018.16.08.11]
2李德育,陈喜军,郑建萍,钟江鸣,郑艳,刘振华,崔同建.不同肠内营养对结肠癌化疗患者肠黏膜屏障保护作用的影响.慢性病学杂志2016;17:1091-1094[DOI:10.16440/j.cnki.1674-8166.2016.10.007]
3 Clavier JB,Antoni D,Atlani D,Ben Abdelghani M,Schumacher C,Dufour P,Kurtz JE,Noel G.Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer.Dis Esophagus2014;27:560-567[PMID:23106980 DOI:10.1111/j.1442-2050.2012.01441.x]
4吕家华,李涛,朱广迎,李杰,赵二,祝淑钗,邢力刚,杨道科,谢丛华,申良方,张海霖,石安辉,王菁,潘闻燕,李昉,王奇峰,郎锦义,石汉平.肠内营养对食管癌同步放化疗患者营养状况、不良反应和近期疗效的影响-前瞻性、多中心、随访对照临床研究(NCT02399306).中华放射肿瘤学杂志2018;27:44-48[DOI:10.3760/cma.j.issn.1004-4221.2018.01.009]
5吕家华,李涛,谢丛华,李杰,邢力刚,张晓智,申良方,赵快乐,赵仁,杨道科,李霞,祝淑钗,孙伟,石汉平.食管癌放疗患者肠内营养专家共识.肿瘤代谢与营养电子杂志2015;2:29-32
6 Eisenhauer EA,Therasse P,Bogaerts J,Schwartz LH,Sargent D,Ford R,Dancey J,Arbuck S,Gwyther S,Mooney M,Rubinstein L,Shankar L,Dodd L,Kaplan R,Lacombe D,Verweij J.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1).Eur J Cancer 2009;45:228-247[PMID:19097774 DOI:10.1016/j.ejca.2008.10.026]
7 Mak M,Bell K,Ng W,Lee M.Nutritional status,management and clinical outcomes in patients with esophageal and gastrooesophageal cancers:A descriptive study.Nutr Diet 2017;74:229-235[PMID:28731604 DOI:10.1111/1747-0080.12306]
8徐桂琼,李民英,雷风,叶奕菁,白玉海,欧阳玉秀,周嘉雄.经鼻肠管肠内营养支持在食管癌放疗患者中的应用.中国基层医药2017;24:228-231[DOI:10.3760/cma.j.issn.1008-6706.2017.02.018]
9 Li HC,Fan XJ,Chen YF,Tu JM,Pan LY,Chen T,Yin PH,Peng W,Feng DX.Early prediction of intestinal mucosal barrier function impairment by elevated serum procalcitonin in rats with severe acute pancreatitis.Panceatology 2016;16:211-217[DOI:10.1016/j.pan.2015.12.177]
10苏赛赛,鲍丽莎.大黄通便颗粒联合早期肠内营养治疗下急性胰腺炎的临床疗效及对肠道黏膜屏障功能的影响.世界华人消化杂志2016;24:2720-2725[DOI:10.11569/wcjd.v24.i17.2720]
11姜雯雯,杨大刚,孙晓红,王惠群.早期肠内营养对食管癌患者放化疗后营养状况及胰岛素抵抗的影响.国际老年医学杂志2016;37:216-219;231[DOI:10.3969/j.issn.1674-7593.2016.05.007]
12王舜尧,柴滨.谷氨酰胺联合膳食纤维强化肠内营养对重症医学科患者的支持效果.世界华人消化杂志2014;22:2626-2631[DOI:10.11569/wcjd.v22.i18.2626]
13 Takesue T,Takeuchi H,Ogura M.Erratum to:A prospective randomized trial of enteral nutrition after troracoscopic esophagectomy for esophageal cancer.Ann Surg Oncol 2016;23:1060-1061[DOI:10.1245/s10434-016-5480-0]
14虞桂平,陈国强,黄斌.老年食管癌患者术后早期肠内营养对营养状况及免疫功能的影响.中华胸心血管外科杂志2016;32:569-573[DOI:10.3760/cma.j.issn.1001-4497.2016.09.017]
15王倩,王军,王祎,景绍武,刘青,曹峰,焦文鹏,杨从容,程云杰,武亚晶.营养状况与炎症指标对食管癌同期放化疗急性不良反应的影响.中华放射肿瘤学杂志2017;26:1012-1018[DOI:10.3760/cma.j.issn.1004-4221.2017.09.007]
16赵桂彬,曹守强,张凯,辛衍忠,韩敬泉,董庆,崔键.早期肠内营养对食管癌患者术后免疫功能和临床结局的影响.中华胃肠外科杂志2014;17:356-360[DOI:10.3760/cma.j.issn.1671-0274.2014.04.014]
17 Zhang Z,Li H.Yan C,Xu C,Hu R,Ma M,Wei H,Meng Y.A comparative study on the efficacy of fast-track surgery in the treatment of esophageal cancer patients combined with metabolic syndrome.Oncol Lett 2017;14:4812-4816[DOI:10.3892/ol.2017.6759]
18 Chan KT,Choi MY,Lai KK,Tan W,Tung LN,Lam HY,Tong DK,Lee NP,Law S.Overexpression of transferrin receptor CD71 and its tumorigenic properties in esophageal squamous cell carcinoma.Oncol Rep 2014;31:1296-1304[PMID:24435655DOI:10.3892/or.2014.2981]
19 Peng J,Cai J,Niu ZX,Chen LQ.Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy:a meta-analysis.Dis Esophagus2016;29:333-341[PMID:25721689 DOI:10.1111/dote.12337]
20李宁,高岭,孟丹丹,弋振营,张红蕊,徐志巧.营养治疗在晚期食管癌同步放化疗过程中早期介入的作用研究.癌症进展2018;16:963-966[DOI:10.11877/j.issn.1672-1535.2018.16.08.11]