不同营养治疗方式对肿瘤患者放疗期间营养状况及免疫功能的影响

Effects of different nutritional treatment methods on the nutritional status and immune function of cancer patients during radiotherapy

目的探讨营养咨询、肠内营养支持、肠外营养支持3种营养治疗方式对肿瘤患者放疗期间营养状况及免疫功能的影响。方法选取2019年1—12月邯郸市中心医院肿瘤科收治的肿瘤放疗患者210例,根据患者意愿分为对照组和肠内营养组、肠外营养组,每组70例。对照组给予营养咨询,常规膳食指导;肠内营养组在对照组基础上予以肠内营养支持治疗;肠外营养组在对照组基础上予以肠外营养支持治疗。统计3组放疗3周后营养不良发生率[采用营养状况主观评价分级(PG-SGA)评估],观察3组营养风险(采用NRS 2002营养风险筛查表评估)和血清营养指标[白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)、血红蛋白(Hb)]、免疫功能相关指标(CD3+、CD4+、CD8+、CD4+/CD8+、IgG、IgM、IgA)变化。结果放疗3周后,对照组营养不良和营养风险发生率分别为87.1%(61/70)和84.3%(59/70),肠内营养组分别为45.7%(32/70)和48.6%(34/70),肠外营养组分别为50.0%(35/70)和54.3%(38/70),肠内营养组和肠外营养组均明显低于对照组(P均<0.05)。放疗3周后,肠内营养组和肠外营养组血清ALB、PA、TRF、Hb、IgG、IgM、IgA水平和CD3+、CD4+、CD4+/CD8+均明显高于对照组(P均<0.05),且肠内营养组均明显高于肠外营养组(P均<0.05);肠内营养组和肠外营养组CD8+均明显低于对照组(P均<0.05),且肠内营养组明显低于肠外营养组(P<0.05)。结论相较于营养咨询,肠内营养支持与肠外营养支持均可不同程度改善肿瘤患者放疗期间营养状况及免疫功能,且肠内营养支持能更好地改善血清营养指标和提高患者免疫功能。

Objective It is to explore the effects of nutrition consultation,enteral nutrition support,and parenteral nutrition support on the nutritional status and immune function of cancer patients during radiotherapy.Methods A total of 210 tumor patients undergoing radiotherapy admitted to the Oncology Department of Handan Central Hospital from January to December 2019 were selected and divided into a control group,an enteral nutrition group,and a parenteral nutrition group according to the wishes of the patients,with 70 cases in each group.The control group was given nutrition consultation and routine dietary guidance,the enteral nutrition group was given enteral nutrition support treatment on the basis of the control group,the parenteral nutrition group was given parenteral nutrition support treatment on the basis of the control group.The incidence of malnutrition[assessed by the subjective evaluation of nutritional status(PG-SGA)]in the 3 groups after 3 weeks of radiotherapy was counted,and the nutritional risks(assessed by the NRS 2002 Nutrition Risk Screening Form)and the changes in serum nutritional indicators[albumin(ALB),prealbumin(PA),transferrin(TRF),hemoglobin(Hb)],immune function related indicators(CD3+,CD4+,CD8+,CD4+/CD8+,IgG,IgM,IgA)of the three groups were observed.Results After 3 weeks of radiotherapy,the incidence of malnutrition and nutritional risk were 87.1%(61/70)and 84.3%(59/70)in the control group,45.7%(32/70)and 48.6%(34/70)in the enteral nutrition group,and 50.0%(35/70)and 54.3%(38/70)in the parenteral nutrition group.Both the parenteral nutrition group and the parenteral nutrition group were significantly lower than the control group(P<0.05).After 3 weeks of radiotherapy,the serum levels of ALB,PA,TRF,Hb,IgG,IgM,IgA and CD3+,CD4+,CD4+/CD8+in the enteral nutrition group and parenteral nutrition group were significantly higher than those of the control group(all P<0.05),and the enteral nutrition group was significantly higher than the parenteral nutrition group(P<0.05);the level of CD8+in the enteral nutrition group and parenteral nutrition group were significantly lower than the control group(P<0.05),and the enteral nutrition group was significantly lower than the parenteral nutrition group(P<0.05).Conclusion Compared with nutrition consultation,enteral nutrition support and parenteral nutrition support can improve the nutritional status and immune function of cancer patients during radiotherapy to varying degrees,and enteral nutrition support can better improve serum nutritional indicators and immune function.