肠内免疫营养联合微生态制剂对进展期胃癌术后辅助化疗的临床作用研究  

Clinical application of enteral immunonutrition combined with probiotics during postoperative adjuvant chemotherapy of advanced gastric cancer

作　　者：王立伟[1] 王键玮 魏秀芹[1] 贾军锋[1] 强薇[1] 贾伟[1] 

机构地区：[1]首都医科大学附属北京康复医院,北京100144 [2]华北理工大学医学院附属医院,河北唐山063001

出　　处：《中国实用内科杂志》2016年第7期591-594,共4页Chinese Journal of Practical Internal Medicine

基　　金：首都医科大学"基础-临床合作研究基金"(14JL39)

摘　　要：目的评价肠内免疫营养联合微生态制剂对进展期胃癌术后辅助化疗患者营养状态、血液学毒性,消化道反应和免疫功能的影响。方法将2013年1月至2015年9月首都医科大学附属北康医院收治的76例进展期胃癌术后辅助化疗患者随机分为肠内免疫营养组(E组,27例)、肠内免疫营养联合微生态制剂组(E^+P组,25例)及对照组(C组,24例)。观察各组患者化疗前后的营养状态、血液学毒性,消化道反应和T细胞亚群的变化。结果与化疗前相比,对照组化疗后体重降低,PA和TF均显著降低(P<0.05),化疗后E组和E^+P组体重较化疗前无明显变化(P>0.05),前白蛋白(PA)和转铁蛋白(TF)显著高于对照组(P<0.05),E组与E^+P组的PA和TF两组间无明显差异(P>0.05)。对照组有11例(45.8%)出现Ⅲ度血液学毒性,而E组出现3例(11.1%),E^+P组仅出现2例(8.0%),差异有统计学意义(P<0.05);E组和E^+P组中消化道反应的发生明显少于对照组(P<0.05),其中E^+P组优于E组(P<0.05)。对照组患者化疗前后辅助性T细胞(CD4^+)和CD4^+/CD8^+比值明显下降(P<0.05),E组及E^+P组反而上升(P<0.05),E组及E^+P组间差异无统计学意义(P>0.05)。结论肠内免疫营养可减轻化疗引发的毒副反应,改善患者的营养状态,增强机体的免疫功能。肠内免疫营养联合微生态制剂可进一步减轻化疗过程中的消化道反应,提高患者治疗期间的生存质量。Objective Enteral immunonutrition combined with probi0tics was used on patients with Advanced Gastric Cancer undergoing Adjuvant Chemotherapy to evaLuate the influence on nutritional statusblood toxiciTY, Digestive tract reaction and immune function. Methods 76 cases of patients with advanced gastric cancer undergoing adjuvant chemotherapy were randomly divided into blank control group（n=24）, enteral immunonutrition group （n=27）and enteral immunonutrition combined with probiotics group （n=25）. The changes of nutritional status, blood cells, digestive tract reaction status and T lymphocyte subsets before and after treatment in each group were evaluated. Results Compared with the levels before chemotherapy, serum prealbumin and transferrin were significantly increased in enteral immunonutrition group and enteral immunonutrition combined with probiotics group after chemotherapy ,while that of control group was significantly declind（P〈0.05）.the incidence of digestive tract reaction in the two enteral immunonutrition groups was significantly less than that in control group（P〈0.05）, and the Enteral immunonutrition combined with probiotics group was better than the enteral immtmonutrition group after chemotherapy（P〈 0.05）. The existence of Grade hematologic toxicity was 45.8% （11 in 24 cases） in control group, while that of control group was 3 （11%）After chemotherapy（P〈0.05）. T helper cells（ CD4＋） and ratio of CD4＋CD8＋（CD4＋/CD8＋）were significantly decreased in blank control group （P〈0.05）. and CD4＋ and CD4＋/CD8＋ were significantly increased in enteral immunonutrition group and enteral immunonutrition combined with probiotics group （P〈0.05）. Condusion Enteral immunonutrition can reduce the side effects of chemotherapy, including malnutrition and blood toxicity, digestive tract reaction and immune function in patients with advanced gastric cancer, improve the nutritional status and enhance immunity ofpatients.Enteral immunonutrition combined w

关 键 词：肠内免疫营养 微生态制剂 化疗 胃癌 

分 类 号：R735[医药卫生—肿瘤] R459[医药卫生—临床医学]