老年食管癌同步放化疗患者肠内营养的临床观察

Clinical assessment of enteral nutrition in elderly esophageal carcinoma patients treated with concurrent chemoradiotherapy

目的探讨在老年食管癌患者行同步放化疗期间,给予肠内营养对治疗并发症、营养指标及免疫细胞亚群的影响。方法病例对照研究,连续入选2020年1-12月在泉州市第一医院收治行同步放化疗的老年食管癌患者108例,按1∶1比例随机分为试验组(肠内营养)54例和对照组(普通饮食)54例。根据数据类型分析两组患者的并发症发生率、营养指标及免疫指标等的差异。结果试验组Ⅰ~Ⅱ、Ⅲ~Ⅳ度骨髓抑制发生率低于对照组,37.0%(20例)比63.0%(34例)和11.1%(6例)比27.8%(15例),差异有统计学意义(χ^(2)值分别为7.259、4.788,P<0.01和P<0.05);放化疗第4周试验组营养指标高于对照组,分别为血红蛋白(121.36±11.63)g/L比(106.45±10.85)g/L、血清总蛋白(73.78±7.79)g/L比(63.12±8.35)g/L、白蛋白(40.95±3.52)g/L比(35.54±4.12)g/L(均P<0.05),T细胞亚群比例高于对照组,CD3+(64.15±5.84)%比(59.25±6.27)%、CD4+(48.64±4.28)%比(45.27±4.52)%,差异有统计学意义(均P<0.05),而T细胞亚群CD8+比例低于对照组,(26.93±3.63)%比(30.35±3.36)%(P<0.05)。结论在老年食管癌患者同步放化疗过程中,根据患者进食量调整给予肠内营养,可降低患者营养风险并调整免疫细胞亚群比例,减少骨髓抑制发生。

Objective To investigate the effects of enteral nutrition on the incidence of treatment complications,results from nutritional indexes and proportions of immune cell subsets in elderly patients with esophageal carcinoma during concurrent chemoradiotherapy.Methods From January 1,2020 to December 31,2020,108 elderly patients(≥60 years)undergone concurrent chemoradiotherapy for esophageal carcinoma at Quanzhou First Hospital and eligible for inclusion were enrolled in the case-control study.They were randomly divided into the study group(enteral nutrition group)and the control group(normal diet group),with 54 cases in each group.The incidence of complications,results from nutritional indexes and immune cell subsets of the two groups were analyzed according to data type.Results The incidence of bone marrow suppression(GradeⅠ-Ⅱ)in the study group(37.0%)was significantly lower than that in the control group(63.0%)(χ^(2)=7.259,P<0.01).The incidence of bone marrow suppression(GradeⅢ-Ⅳ)in the study group(11.1%)was significantly lower than that in the control group(27.8%)(χ^(2)=4.788,P<0.05).The levels of hemoglobin,total serum protein and albumin were(121.36±11.63)g/L,(73.78±7.79)g/L and(40.95±3.52)g/L in the study group and(106.45±10.85)g/L,(63.12±8.35)g/L and(35.54±4.12)g/L in the control group,respectively,after 4 weeks of radiotherapy and chemotherapy(P<0.05).The proportions of CD3+and CD4+were(64.15±5.84)%and(48.64±4.28)%in the study group and(59.25±6.27)%and(45.27±4.52)%in the control group,respectively,after 4 weeks of radiotherapy and chemotherapy(P<0.05).The proportion of CD8+was(26.93±3.63)%in the study group and(30.35±3.36)%in the control group after 4 weeks of radiotherapy and chemotherapy(P<0.05).Conclusions During concurrent chemoradiotherapy for elderly patients with esophageal carcinoma,enteral nutrition with adjustment based on patient's food intake can reduce patients'nutritional risk and modulate the proportion of immune cell subsets,thus reducing the occurrence of bone marrow suppression.