非小细胞肺癌化疗联合部分肠外营养对细胞免疫的影响

INFLUENCE ON CELLULAR IMMUNITY BY PARTIAL PARENTERAL NUTRITION IN NON-SMALL CELL LUNG CANCER PATIENTS DURING CHEMOTHERAPY

目的通过对非小细胞肺癌(NSCLC)患者化疗期间应用部分肠外营养(PPN)支持治疗的前瞻性临床试验,阐明不同供氮量的营养支持方案对化疗期间机体细胞免疫功能的影响。方法将NSCLC患者随机分为三组:对照组、低剂量PPN组和高剂量PPN组。分别于化疗前后检测CD3+、CD4+、CD8+、NK细胞的百分率和CD4+/CD8+值。结果各组化疗后NK细胞、CD3+、CD4+的百分率与化疗前相比显著降低(P<0.05),其中对照组和低剂量组化疗后的NK细胞降低非常显著(P<0.01);高、低剂量组化疗前后CD3+、CD4+、CD4+/CD8+的变化与对照组相比有统计学意义(P<0.05);高、低剂量组的CD8+、CD4+/CD8+变化无统计学意义(P>0.05)。结论化疗可降低NSCLC患者的细胞免疫功能,而给予含9-复合氨基酸的肠外营养支持可能阻止化疗期间细胞免疫功能的降低。

Objective A clinical trial of giving partial parenteral nutrition （PPN） to non-small cell lung cancer （NSCLC） patients during chemotherapy was carried out to elucidate the influence of different modes of nutritional support on immunological function of T-lymphocyte. Furthermore, the results might give a theoretical explanation for choosing an effective method when PPN was used as a supportive treatment during chemotherapy. Methods 93 patients with non-small cell lung cancer were randomly divided into three groups： the control group （ 30 patients ）, the low dose group （ 32 patients ） and the high dose group （ 31 patients ）. Exactly the same kind of chemotherapy was applied to each patient of these three groups. During chemotherapy, three groups were supplied the same diet, the control group received conventional diet treatment; the low dose group and the high dose group received additional parenteral nutritional support besides diet. The low dose group was given 250ml/d 9-AA and the high dose group was given 500ml/d. The subsets of T-lymphocyte CD3^＋, CD4^＋, CD8^＋ and the percentage of NK cells were detected before and after chemotherapy respectively. Results In all of these three groups, NK cells, CD3^＋ and CD4^＋ decreased significantly alter chemotherapy （ P 〈 0.05 ）. For the control group and low dose group, NK cells reduced much significantly after chemotherapy （P 〈 0.01）. The percentage of CD3^＋, CD4^＋ CD4^＋/CD8^＋ in the low dose group and that in the high dose group were notably higher than those indices in the control group after chemotherapy （ P 〈 0.05 ）, while the percentage of CD8^＋, CD4^＋/CD8^＋ between the low dose group and high dose group had no notable difference （ P 〉 0.05 ）. Conclusions To apply chemotherapy to patients with NSCLC will possibly cause malnutrition and aggravation of immunosuppression. The benefits of giving 9-AA to NSCLS patients who receive PPN during chemotherapy may include antagonizing aggravation of immunolosuppressive function, improved nutritional statns and augmented immunological functions of the T-lymphocytes.