补充谷氨酰胺、EPA、支链氨基酸对食管癌同步放化疗及胃癌术后辅助化疗患者营养状况、治疗顺应性及生活质量的影响

发布时间：2018-05-03 20:02

本文选题：消化道恶性肿瘤 + 化疗　；参考：《北京协和医学院》2015年博士论文

【摘要】：研究目的：研究补充谷氨酰胺、EPA、支链氨基酸对食管癌同步放化疗及胃癌术后辅助化疗患者的作用。研究方法：前瞻性随机对照研究。入组患者选择：自2013年4月至2014年4月因食管癌、胃癌在中国医学科学院肿瘤医院及桓兴病区内科、放疗科住院拟行同步化放疗或化疗的患者104例,符合入组标准及排除标准,并自愿参加研究,其中食管癌同步放化疗患者48例,胃癌术后辅助化疗患者56例。随机入组：使用随机数字表法,将患者按病种不同分别随机,分为2组：试验组和对照组,各52例。干预方法：两组的抗肿瘤治疗手段相同,营养干预均在营养支持小组的管理下,两组均进行膳食指导及常规营养支持,试验组在膳食指导及常规营养支持的基础上给予补充谷氨酰胺(20 g/d)、EPA (3.3 g/d)、支链氨基酸(8 g/d),对照组不进行额外补充谷氨酰胺、EPA、支链氨基酸。评价：食管癌放化疗结束、胃癌3周期化疗结束时,比较治疗前后两组患者人体成分分析结果、部分血液学指标、并发症发生率、治疗完成率。同时采用欧洲癌症研究与治疗组织(European Organisation for Research and Treatment of Cancer, EORTC)制订的用于测评癌症生命质量的专用量表EORTC QLQ-C30主量表及子量表EORTC QLQ-OES18,对治疗前后的食管癌、胃癌患者生命质量各维度指标进行测评。按照EORTC QLQ评分标准对两组患者的生命质量维度指标结果进行调查,功能维度得分越高,功能越好；症状维度得分越高,症状越重。研究结果：人体成分分析结果：试验组治疗前后体重稳定(0.46±2.19,p0.05),而对照组体重显著下降(-2.52±2.57,p0.05)；试验组非脂组织重量(1.40±2.33,p0.05)及骨骼肌重量(0.98±3.09,p0.05)均显著增加,而对照组显著降低(p0.05)。部分血液指标：试验组血白蛋白、红细胞、白细胞、血小板保持稳定(p0.05),而对照组均显著下降(p0.05)。感染相关并发症发生率：试验组低于对照组(6% vs 19%),差异有显著意义(p0.05)。试验组按治疗计划完成率显著高于对照组(96% vs 83%,p0.05)。治疗后的试验组患者在胃食管返流症状、疼痛、综合生命质量维度等方面得分优于对照组,差异有统计学意义。但在症状性维度及其他功能指标得分两组患者之间的差别无统计学意义。两组患者的症状性指标均较治疗前明显升高,功能性指标均比治疗前降低,说明患者的生活质量在放化疗后有所降低,生活质量受到放化疗的影响。结论：对于食管癌同步放化疗及胃癌术后辅助化疗患者,在常规膳食指导及营养支持中补充谷氨酰胺、EPA、支链氨基酸有利于维持患者的营养状况、降低并发症发生率、提高患者的治疗顺应性,与未补充的患者相比可提高其生活质量。
[Abstract]:Objective: to study the effects of supplementation of Glutamine EPA and branched-chain amino acids on concurrent radiotherapy and chemotherapy for esophageal carcinoma and postoperative adjuvant chemotherapy for gastric cancer. Methods: prospective randomized controlled trial. Selection of patients: from April 2013 to April 2014, 104 patients with esophageal cancer and gastric cancer were admitted to Huanxing Department of Internal Medicine, Huanxing Hospital of Chinese Academy of Medical Sciences. The patients in the department of radiotherapy were scheduled to undergo concurrent chemotherapy or radiotherapy, which met the criteria of admission and exclusion. There were 48 patients with esophageal carcinoma and 56 patients with adjuvant chemotherapy after operation. The patients were randomly divided into two groups: experimental group (n = 52) and control group (n = 52). Intervention methods: the two groups had the same anti-tumor therapy. The nutrition intervention was managed by the nutrition support group. The two groups were given dietary guidance and routine nutrition support. On the basis of dietary guidance and routine nutritional support, the experimental group was given 20 g / d of glutamine and 3. 3 g / d ~ (-1) of EPA, 8 g / d ~ (-1) of branched amino acids, while the control group was not given additional supplementation of Glutamine (EPA) and branched chain amino acid (BCAA). Evaluation: at the end of radiotherapy and chemotherapy for esophageal carcinoma and the end of 3-cycle chemotherapy for gastric cancer, the results of human component analysis, some hematological indexes, the incidence of complications and the completion rate of treatment were compared between the two groups before and after treatment. At the same time, the European Organization for Research and treatment of Cancer (Organisation for Research and Treatment of Cancer, EORTC) was used to evaluate the quality of life of cancer. The main and sub-scales EORTC QLQ-OES18 were used to evaluate esophageal cancer before and after treatment. The quality of life (QOL) of gastric cancer patients was evaluated. According to the EORTC QLQ score, the quality of life dimension of the two groups were investigated. The higher the score of functional dimension, the better the function, and the higher the score of symptom dimension, the more serious the symptom. Results: the results of human component analysis showed that the body weight of the experimental group was stable (0.46 卤2.19) and that of the control group was significantly lower than that of the control group (P < 0.05). The weight of non-fat tissue and skeletal muscle in the test group were significantly increased, and the weight of non-fat tissue and skeletal muscle were increased significantly, while that of the control group was significantly lower than that of the control group (1.40 卤2.33) and 0.98 卤3.09 p0.05, respectively. Some blood indexes: serum albumin, red blood cell, white blood cell and platelets remained stable in the test group, while in the control group, the serum albumin, red blood cell, white blood cell and platelets decreased significantly. The incidence of infection related complications in the trial group was 6% lower than that in the control group (P 0.05). The completion rate of treatment plan in the trial group was significantly higher than that in the control group (96% vs 83%, p 0.05). The scores of gastroesophageal reflux symptoms, pain, comprehensive quality of life dimension in the trial group were better than those in the control group after treatment, and the difference was statistically significant. However, there was no significant difference between the two groups in the score of symptomatic dimension and other functional indicators. The symptom indexes of the two groups were significantly higher than those before treatment, and the functional indexes were lower than those before treatment, indicating that the quality of life of the patients decreased after radiotherapy and chemotherapy, and the quality of life was affected by radiotherapy and chemotherapy. Conclusion: for patients with esophageal cancer treated by concurrent radiotherapy and chemotherapy and adjuvant chemotherapy after gastric cancer surgery, supplementation of Glutamine EPA in routine dietary guidance and nutritional support is beneficial to maintain nutritional status of patients and reduce the incidence of complications. Improve the patient's therapeutic compliance and improve their quality of life as compared with those without supplementation.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735

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