化疗对老年非小细胞肺癌患者营养状况及生命质量的影响

Effect of chemotherapy on nutritional status and quality of life in elderly patients with non-small cell lung cancer

目的观察化疗对临床中经基因检测无法进行分子靶向药物治疗的60岁及以上Ⅲ、Ⅳ期非小细胞肺癌患者营养状况及生命质量的影响。方法将60岁及以上Ⅲ、Ⅳ期非小细胞肺癌患者100例，根据主要化疗药物不同分为观察组和对照组，每组50例，观察组患者采用GP方案（吉西他滨＋顺铂）化疗，对照组患者采用TP方案（紫杉醇＋顺铂）化疗，比较两组患者治疗后营养相关指标及生活质量评分。结果化疗后GP方案化疗组体质量、体质量指数、血浆总蛋白、血浆白蛋白、三酰甘油浓度明显低于TP方案化疗组（P分别为〈0.0001、0.0027、0.0305、〈0.0001、〈0.0001）；化疗后总体健康状况评分、躯体功能、角色功能、情绪功能项目评分GP方案组高于TP方案组（P分别为0.0017、0.0044、0.0064、0.006），气促、失眠、食欲下降、便秘、腹泻项目评分GP方案组低于TP方案组（P分别为0.0067、〈0.0001、0.0026、0.0066、0.0023）；GP方案化疗临床有效率为56.0%，高于TP方案组30.0%（χ2＝6.90，P＝0.009）。观察组Ⅰ级不良反应发生率较高（54.0%）；对照组Ⅱ级、Ⅲ级及Ⅳ级发生率较高，分别为36.0%、24.0%及24.0%，2组比较差异有统计学意义（χ2＝16.40，P＝0.001）。结论TP化疗方案更加有利于患者营养，而GP化疗方案具有更高的临床疗效及更有利于改善患者的生命质量。

ObjectiveTo observe the effects of chemotherapy on nutritional status and quality of life in elderly patients aged 60 years and over with stage Ⅲ or Ⅳ non-small-cell lung cancer, who were unable to undergo molecular-targeted drug therapy according to genetic testing. MethodsA total of 100 elderly patients with stage Ⅲ or Ⅳ non-small cell lung cancer were randomized into an observation group（n=50）and a control group（n=50）. Patients in the observation group were treated with GP regimen（gemcitabine＋ cisplatin）, while patients in the control group were treated with TP regimen（paclitaxel＋ cisplatin）. The scores of nutritionally relevant indicators and quality of life were compared between the two groups.ResultsAfter chemotherapy, the body weight, body mass index, plasma total protein, plasma albumin, and triglyceride concentrations were significantly lower in the GP regimen group than in the TP regimen group（P〈0.0001, P=0.0027, P=0.0305, P〈0.0001, P〈0.0001, respectively）. The overall health status score, physical function, role function, and emotional function scores were higher in the GP group than in the TP group（P=0.0017, 0.0044, 0.0064, 0.006, respectively）after chemotherapy.The scores of shortness of breath, insomnia, loss of appetite, constipation, and diarrhea were significantly lower in the GP group than in the TP group（P=0.0067, P〈0.0001, P=0.0026, P=0.0066, P=0.0023）. The clinical effective rate was significantly higher in GP regimen than in TP regimen（56.0% vs 30.0%, χ2=6.90, P=0.009）. The incidence of grade I adverse reactions was higher in the observation group（54.0%, 27/50 cases）, and the incidences of grade Ⅱ, Ⅲ and Ⅳ adverse reactions were higher in the control group（36.0%, 18/50 cases; 24.0%, 12/50 cases; and 24.0%, 12/50 cases, respectively）（χ2=16.40, P=0.001）.ConclusionsThe TP chemotherapy is more beneficial to patients＇ nutrition, while the GP chemotherapy can achieve both higher clinical efficacy and better quality of life.