免疫肠内营养对老年晚期肺癌化疗患者营养状况的影响

Immune enteral nutrition on elderly advanced lung cancer patients with chemoherapy

目的探讨免疫营养治疗对老年晚期NSCLC化疗患者的疗效。方法选取我院收治的老年晚期NSCLC患者91例,分为免疫增强型肠内营养干预组(Ⅰ组29例,日常饮食+瑞能1,000ml/d)、常规肠内营养干预组(Ⅱ组32例,日常饮食+能全力1,000ml/d)和对照组(Ⅲ组30例,日常饮食)。化疗前1天及化疗后1个月、2个月、3个月,检测体重、体质指数、AC、ALB、HB、PG-SGA等。记录并比较三组患者化疗期间肺部感染、乏力、恶心、呕吐、腹泻、便秘等不良反应差异。结果 91例老年晚期NSCLC患者均完成至少3周期化疗。三组患者化疗后AC、ALB、HB等营养状况指标较化疗前下降,PG-SGA评分较化疗前上升,差异具有统计学意义。其中,第Ⅲ组患者营养指标恶化趋势明显高于其他两组,而Ⅰ组AC、HB下降趋势小于Ⅱ组,Ⅰ组PG-SGA评分增加趋势小于Ⅱ组,差异具有统计学意义。结论化疗可以使老年晚期NSCLC患者的营养状况恶化。和常规饮食相比,补充肠内营养液可以维持体重,减缓营养状况的恶化。相比于标准肠内营养,免疫增强型肠内营养可以更好地改善AC、PG-SGA评分,减少化疗期间出现肺部感染的概率,因此认为免疫增强型肠内营养效果更好。

Objective To Investigate the effect of immune nutrition on elderly advanced NSCLC patients with chemoherapy. Methods 91 cases of elderly advanced NSCLC patients were selected from our hospital. They were divided into three groups, the first group was immune-enhanced enteral nutrition intervention group （29 patients with normal diets supplemented with immune enhanced enteral nutrition 1,000ml/d）, the second group was conventional enteral nutrition intervention group （32 patients supplemented with conventional enteral nutrition 1,000ml/d）, the third group was control group （30 patients supplemented with normal diet）. We recorded indicators of patients 1 day before chemotherapy and 1 month, 2 months, 3 months after treatment separately including weight, BMI, AC, ALB, HB and PG-SGA score. Then, we compared the differences of adverse reactions among these three groups, such as pulmonary infection, fatigue, nausea, vomiting, diarrhea and constipation. Results All the 91 cases patients completed at least 3 cycles of chemotherapy. Nutritional indicators such as AC, ALB, HB were decreased after chemotherapy in all patients, but PG-SGA scores raised, with signifcant difference. In group III, nutritional indicators deteriorated signifcantly higher than other two groups. However, in group I, the decrease of AC, HB and the increase of PG-SGA were less than group II, with statistical differences. Conclusions Chemotherapy could make elderly advanced NSCLC patients worsening in nutritional status. Compared with conventional dietary, supplemented enteral nutrition could serve to maintain body weight and slow down the deterioration of the nutritional status. In addition, compared with standard enteral nutrition, immune enhanced enteral nutrition can better improve AC and PG-SGA score, while reducing the probability of pulmonary infections during chemotherapy, therefore, we believed that the immune-enhancing enteral nutrition is better.