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影响

Impact of glutamine, eicosapntemacnioc acid, branched-chain amino acid supplements on nutritional status and treatment compliance of esophageal cancer patients on concurrent chemoradiotherapy and gastric cancer patients on chemotherapy

目的 观察补充谷氨酰胺、二十碳五烯酸（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.方法 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和北京桓兴病区拟行化疗或同步化放疗患者104例入组,数字随机分为试验组和对照组进行营养干预,两组均进行膳食指导及常规营养支持,试验组给予补充谷氨酰胺（20 g/d）、EPA （3.3 g/d）、支链氨基酸（8 g/d）,对照组不进行补充.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.结果 试验组非脂组织及骨骼肌重量均显著增加,而对照组显著降低（P＜0.05）;试验组血白蛋白、红细胞、白细胞、血小板保持稳定（P＞0.05）,而对照组均显著下降;感染相关并发症发生率,试验组显著低于对照组（6％与19％,P＜0.05）;此外,试验组按治疗计划完成率显著高于对照组（96％与83％,P＜0.05）.结论 对于食管癌同步放化疗及胃癌术后辅助化疗患者,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.

Objective To explore the effects of glutamine,eicosapntemacnioc acid （EPA） and branched-chain amino acids supplements in esophageal cancer patients on concurrent chemoradiotherapy and gastric cancer patients on chemotherapy.Methods From April 2013 to April 2014,a total of 104 esophageal and gastric carcinoma patients on chemotherapy or concurrent chemoradiotherapy were recruited and randomly divided into experimental and control groups.Both groups received dietary counseling and routine nutritional supports while only experimental group received supplements of glutamine （20 g/d）,EPA （3.3 g/d） and branched-chain amino acids （8 g/d）.And body compositions,blood indicators,incidence of complications and completion rates of therapy were compared between two groups.Results After treatment,free fat mass and muscle weight increased significantly in experiment group while decreased in control group （P ＜ 0.05）.And albumin,red blood cell count,white blood cell count and blood platelet count remained stable in experiment group while declined significantly in control group.During treatment,compared to control group,the incidences of infection-associated complication were lower （6％ vs 19％,P ＜ 0.05） and the completion rates of therapy were significantly higher in experiment group （96％ vs 83％,P ＜ 0.05）.Conclusion Supplements of glutamine,EPA and branched-chain amino acids can help maintain nutrition status,decrease the complications and improve compliance for esophageal cancer patients on concurrent chemo-radiotherapy and gastric cancer patients on postoperative adjuvant chemotherapy.