Changes in the nutritional status of nine vitamins in patients with esophageal cancer during chemotherapy

BACKGROUND Many studies have investigated the relationships between vitamins and esophageal cancer(EC).Most of these studies focused on the roles of vitamins in the prevention and treatment of EC,and few studies have examined the changes in vitamin nutritional status and their influencing factors before and after chemotherapy for EC.Chemotherapy may have a considerable effect on EC patients’vitamin levels and hematological indicators.AIM To research the nutritional status of multiple vitamins in EC patients during chemotherapy and to assess its clinical significance.METHODS EC patients admitted to our center from July 2017 to September 2020 were enrolled in this study.Serum concentrations of nine vitamins(A,D,E,B9,B12,B1,C,B2 and B6),hemoglobin,total protein,albumin,blood calcium,blood phosphorus concentrations and body mass index(BMI)were measured in all EC patients.The changes in nine vitamins,hematological indicators and BMI were compared before and after two cycles of chemotherapy.The possible influential factors were analyzed.RESULTS In total,203 EC patients receiving chemotherapy were enrolled in this study.Varying degrees of vitamin A,D,C and B2 deficiency and weight loss were found in these patients,and the proportions of vitamin B2 and vitamin C deficiencies increased significantly after chemotherapy(both P<0.05).Serum concentrations of vitamins A,C,B2 and B6 and BMI before and after chemotherapy were statistically significant(all P<0.05).Multivariate analysis showed that vitamin A levels significantly differed between male and female EC patients,whereas vitamin D concentration significantly differed in EC patients in different stages(all P<0.05).Correlations were observed between the changes in serum concentrations of vitamin A and C before and after two cycles chemotherapy and the change in BMI(P<0.05).Hemoglobin,total protein,serum albumin and blood calcium concentrations significantly decreased in EC patients after chemotherapy(all P<0.05),while the blood phosphorus level significantly increased after chemotherapy(P<0.05).Using the difference in vitamin concentrations as the independent variables and the difference in BMI as the dependent variable,logistic regression analysis revealed statistically significant differences for vitamin A,vitamin D and vitamin C(F=5.082,P=0.002).CONCLUSION Vitamin A,D,C and B2 were mainly deficient in patients with EC during chemotherapy.Multivitamin supplementation may help to improve the nutritional status,chemotherapy tolerance and efficacy.

Effects of enteral nutrition intervention on immune nutritional status and radiation damage in patients with esophageal cancer radiotherapy

Objective: To study the effects of enteral nutrition intervention on immune nutritional status and radiation damage in patients with esophageal cancer radiotherapy. Methods: Patients with esophageal cancer who underwent radiotherapy in West China Hospital, Sichuan University between January and October 2017 were chosen as the research subjects and divided into the experimental group who received enteral nutrition intervention and the control group who received routine intervention. The contents of nutrition indicators and radiation damage markers in serum as well as the contents of immune cells in peripheral blood were determined before radiotherapy and after radiotherapy ended. Results: Compared with those before radiotherapy, serum ALB, PA, TRF and RBP contents as well as peripheral blood Th cell, NK cell, Breg cell and Treg cell contents of experimental group did not change significantly while serum PDGF-BB, TGF-β1, CTGF, TNF-α and SAA contents were significantly higher after radiotherapy;serum ALB, PA, TRF and RBP contents as well as peripheral blood Th cell and NK cell contents of control group were significantly lower while serum PDGF-BB, TGF-β1, CTGF, TNF-α and SAA contents as well as peripheral blood Breg cell and Treg cell contents were significantly higher after radiotherapy;serum ALB, PA, TRF and RBP contents as well as peripheral blood Th cell and NK cell contents of experimental group after radiotherapy were higher than those of control group while serum PDGF-BB, TGF-β1, CTGF, TNF-α and SAA contents as well as peripheral blood Breg cell and Treg cell contents were lower than those of control group. Conclusion: enteral nutrition intervention can improve immune nutritional status and reduce radiation damage in patients with esophageal cancer radiotherapy.

Advantages of nasogastric tube feeding during neoadjuvant concurrent chemoradiotherapy for esophageal cancer:A retrospective study

ObjectiveTo compare the effects of oral intake and nasogastric tube(NG)feeding on nutritional status,complications and survival during neoadjuvant chemoradiotherapy for esophageal squamous-cell carcinoma(ESCC)patients.MethodsA total of 61 ESCC cases treated with neoadjuvant chemoradiotherapy from December 2018 to March 2020 were enrolled,including(38 in oral intake group,and 22 in NG feeding group.Disease characteristics and baseline nutritional markers were collected in both groups.Nutritional status,complication and completion rate of chemoradiotherapy in both groups were evaluated.ResultsCompared with the oral intake group,patients in the NG feeding group had a later T stage(P=0.027)and clinical stage(P=0.014).The levels of energy intake(P=0.033),serum prealbumin(P<0.001),albumin(P=0.017)and hemoglobin(P=0.015)before treatment in NG group were significantly lower than those in oral intake group.Furthermore,patient-generated subjective global assessment(PG-SGA)score(P=0.016)and the levels of serum C-reactive protein(P=0.014)of NG feeding group were significantly higher than those of oral intake group.However,at the end of treatment,PG-SGA scores were increased in oral intake group and decreased in NG feeding group.In addition,the NG feeding group had a lower incidence of grade≥2 esophagitis(P=0.037),and higher completion rate of chemotherapy compared with oral intake group(P=0.034).Meanwhile,the proportion of parenteral nutrition(P=0.008)and anti-inflammatory(P=0.022)treatment in NG feeding group was significantly lower than that in oral intake group.Although patients in the NG feeding group had a worse prognosis,there were no statistically significant differences in overall survival(OS)and progression-free survival(PFS)between the two groups(P>0.05).ConclusionsAs a safe and effective enteral nutrition approach to improving nutrition,nasogastric tube feeding could increase treatment completion rate and reduce the incidence of≥grade 2 esophagitis reaction during neoadjuvant chemoradiotherapy.

林州市食管癌高发区人群维生素营养状况的动态变化研究

目的了解林州市食管癌高发区人群维生素营养状况的动态变化。方法采用生态学对比研究的方法,在林州市选择曾经进行过营养调查的8个乡,每乡2村,每村随机抽取30户居民为研究对象,采集血样和4h负荷尿,测定血清维生素A,血浆总抗坏血酸,红细胞谷胱甘肽还原酶活性系数分别采用三氟乙酸比色法,2,4二硝基苯肼法和Sauberlich法,尿中核黄素,还原型抗坏血酸,总抗坏血酸排出量分别采用荧光法,2,6二氯酚靛酚滴定法和2,4二硝基苯肼法,测定结果与1982年、1983年和1984年的调查结果进行比较分析,采用t检验或χ2检验。结果任村、东姚和河涧三个乡的居民血清维生素A显著高于1982年的结果(P<0.01);姚村、任村和河顺三个乡的居民4h负荷尿核黄素排出量显著高于1983年或1984年的结果(P<0.01);以4h负荷尿核黄素排出量和红细胞谷胱甘肽还原酶活性系数评价核黄素营养状况发现东姚、河涧、姚村、任村四个乡的居民核黄素缺乏的人数显著低于1982年或1983年的结果(P<0.01);以血浆总抗坏血酸水平及4h负荷尿中抗坏血酸排出量平均值评价维生素C营养状况发现东姚、河涧、姚村、任村和河顺五个乡的居民总抗坏血酸缺乏的人数显著低于1982年或1983年的结果(P<0.01)。结论食管癌高发区林州市居民维生素A,B2,C的营养状况有了明显的改善。

食管癌术后维生素D联合肠内免疫营养对患者免疫功能调节的影响

目的探讨维生素D联合肠内免疫营养是否能提高食管癌术后患者的免疫功能。方法选择我院普外科2012年11月至2014年11月50例食管癌患者,根据入院顺序进行编号,使用完全随机化分组法将病例分为肠外营养(PN)组(n=12)、维生素D联合肠外营养(Vit D+PN)组(n=13)、肠内免疫+肠外营养(EIN+PN)组(n=12)和维生素D联合肠内免疫,肠外营养(Vit D+EIN+PN)组(n=13)。各组均于术后2 d开始给予肠内免疫营养或全肠外营养,维生素D均在术后马上补充。各组分别在术前1 d、术后4 d及8 d检测血清免疫球蛋白(Ig G、Ig A、Ig M)、外周血T淋巴细胞亚群(CD3+、CD4+、CD8+以及CD4+/CD8+),分析各组是否存在差异。结果 Ig A、CD3+、CD4+、CD8+于术后4 d各组间比较差异均有统计学意义(P<0.01),其中Vit D+EIN+PN组的Ig A、CD3+、CD4+、CD8+分别为(2.48±0.62)g/L、(60.53±4.16)%、(32.89±3.65)%、(30.42±3.71)%,PN组分别为(1.78±0.49)g/L、(55.56±4.73)%、(27.89±2.68)%、(31.72±3.56)%。术后8 d,血清免疫球蛋白及外周血T淋巴细胞亚群各指标各组间比较差异均有显著统计学意义(P<0.01),Vit D+EIN+PN组各免疫指标分别为Ig G:(13.42±3.05)g/L,Ig A:(3.27±0.92)g/L,Ig M:(1.36±0.32)g/L,CD3+:(67.78±6.36)%,CD4+:(37.92±4.50)%,CD8+:(26.86±4.16)%,CD4+/CD8+:(1.48±0.32),在各组中免疫增强效果最为明显。结论维生素D与肠内免疫营养均具有增强免疫之效果,两者联合用于食管癌术后可获得更好效果,减少感染的发生。

食管癌化疗患者维生素水平变化横断面研究

目的研究食管癌患者化疗期间维生素水平变化情况。方法选取2017年7月至2020年9月中国人民解放军联勤保障部队第九一〇医院243例接受化疗的食管癌患者的临床资料。检测食管癌患者化疗前1周内、化疗2个周期后的血维生素A、B1、B2、B6、B9(叶酸)、B12、C、D、E共9种维生素水平、血液学指标和体质指数(BMI)的变化。比较食管癌患者化疗2个周期后9种维生素缺乏例数和平均水平的变化情况。使用Pearson相关分析患者化疗前后各种维生素水平差异与BMI变化间的相关性。结果纳入的243例患者年龄39~76岁,平均(60.14±8.26)岁。食管癌分期以Ⅲ期117例(48.15%)和Ⅳ期80例(32.92%)为主。初始治疗前的食管癌患者存在维生素A、B2、C、D水平不足(均P<0.05)。化疗2个周期后,患者维生素A、B2、B6和C水平显著降低(均P<0.05)。化疗2个周期后患者的体质指数、血红蛋白、总蛋白、血清白蛋白和血钙水平降低(均P<0.05),血磷水平显著升高(P<0.05)。化疗前及化疗2个周期后患者的血维生素A(r=0.343,P<0.001)和C水平(r=0.388,P<0.001)变化与体质指数的变化呈正相关。结论接受化疗的食管癌患者存在维生素A、B2、C和D缺乏。