摘要
目的 阿帕替尼是目前首个治疗晚期化疗耐药胃癌患者的有效口服抗肿瘤血管生成药物，该研究旨在探讨免疫肠内营养对晚期胃癌患者使用阿帕替尼治疗后营养状况及不良反应的影响。方法 选取我院2016年1月至2018年9月期间收治的108例晚期胃癌患者作为研究对象，采用随机数表法分为观察组（免疫肠内营养）和对照组（普通饮食指导）各54例，观察组给与免疫肠内营养剂（瑞能，华瑞制药公司，200ml/瓶）联合阿帕替尼，对照组给与普通饮食营养指导联合阿帕替尼，治疗前后进行营养和代谢指标、治疗不良反应、疗效以及院内感染率的观察，对观察数据进行统计及分析。结果 治疗前两组患者的年龄、性别、肿瘤类型、营养指标均无统计学差异（P>0.05）。经过两周期的阿帕替尼治疗后，观察组的PG-SGA、BMI、血清白蛋白、血清前白蛋白等营养指标均显著优于对照组，院内感染率显著低于对照组，其差异均有统计学意义（P<0.05）。2周期治疗后，观察组的BMI、ALB、PA较治疗前明显升高，而对照组的BMI、Hb、ALB、PA较治疗前均显著下降（P<0.05）。在阿帕替尼药物不良反应方面，观察组中乏力、骨髓抑制、腹泻等不良反应发生率均显著低于对照组（P<0.05），但两组患者的疗效无显著差异（P>0.05）。结论 抗血管生成治疗期间使用免疫增强型肠内营养可以显著改善晚期胃癌患者的营养状态，并有效减轻治疗相关消化道和骨髓抑制等不良反应，降低院内感染发生率。
Abstract
Objective Apatinib is currently the first effective oral anti-tumor angiogenesis drug for the treatment of patients with advanced chemotherapy-resistant gastric cancer. This study is to explore the effects of immune enteral nutrition treatment on the nutritional status and toxicity of advanced gastric cancer patients undergoing apatinib. Methods From January 2016 to September 2018，108 patients with gastric cancer selected from Aviation Gerneral Hospital were randomly divided into the treatment group and the control group. The observation group (n = 54) was treated with immune enteral nutritional support and apatinib， the control group (n = 54) was given normal diet direction and apatinib. Before and after 2 cycles， two groups were assessed and evaluated in terms of the nutritional status， toxicity reaction and nosocomial infection rate. Results Before treatment， the clinical data such as mean age， gender， types of cancer and nutritional index between the two groups were all no statistical significance (P>0.05). After treatment， the body mass index， albumin level and prealbumin level of observation group were all significantly better than those of the control group. The incidence of nosocomial infection in the observation group was significantly lower than in the control group (P<0.05). After two cycles of treatment， the body mass index， albumin level and prealbumin level of observation group were all higher than before (P<0.05). In contrast， the body mass index， hemoglobin， albumin and prealbumin level of control group were all lower than before (P<0.05).Regarding the adverse reactions of apatinib， the incidences of fatigue， myelosuppression and diarrhea were all significantly different(P<0.05). However， there was no statistical difference of efficiency between the two groups. Conclusions Providing enteral nutritional therapy to advanced gastric cancer patients undergoing antiangiogenic treatment can not only improve the nutrition status， but also alleviate the antiangiogenic-induced adverse reaction and the incidence of nosocomial infection.
关键词
免疫肠内营养 /
晚期胃癌 /
阿帕替尼
Key words
Immune enteral nutrition /
Gastric cancer /
Apatinib
常戈鋆.
免疫肠内营养对阿帕替尼治疗晚期胃癌患者的影响[J]. 肿瘤代谢与营养电子杂志. 2019, 6(2): 230-235
CHANG Ge-yun.
Immune enteral nutrition on advanced gastrointestinal cancer patients undergoing apatinib[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2019, 6(2): 230-235
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参考文献
1.Torre LA， Bray F， Siege RL， et al.Global cancer statistics，2012.CA Cancer J Clin. 2015；65(2):87-108.
2.Chen W， Zheng R， Baade PD， et al.Cancer statistics in China，2015.CA Cancer J Clin. 2016；66(2):115-132.
3.Li J，Qin S， Xu J， et al.Apatinib for chemotherapy-refractory advanced metastatic gastric cancer: results from a randomized， placebo-controlled， parallel-arm， phase Ⅱ trial.J Clin Oncol. 2013；31(26):3219-3225．
4.Li J，Qin S， Xu J， et al. Randomized， double-blind， placebocontrolled phase Ⅲ trial of apatinib in patients with chemotherapy-refractory advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction.J Clin Oncol. 2016；34(13):1448-1454．
5.赵青芳，关露露，吕慧芳，等.阿帕替尼治疗晚期胃癌的疗效预测和预后分析.中国肿瘤杂志. 2018；28(3):203-209.
6.姚艺玮，何义富，胡冰，等.阿帕替尼治疗晚期胃癌临床观察.中华肿瘤防治杂志. 2017；24(6):389-393.
7.Argiles JM， Busquets S， Stemmler B， et al.Cancer cachexia:understanding the molecular basis.Nat Rev Cancer. 2014；14(11):754-762.
8.Di FA， Lecleire S， Gangloff A， et al.Impact of nutritional parameter variations during definitive chemoradiotherapy in locally advanced oesophageal cancer.Dig Liver Dis. 2014；46(3):270-275.
9.Gupta D， Lis CG， Granick J， et al.Malnutrition was associated with poor quality of life in colorectal cancer: a retrospective analysis. J Clin Epidemiol. 2006；59(7):704-709.
10.Lv JH， Li T， Zhu GY， et al.Enteral nutrition for esophageal cancer patients with concurrent chemoradiotherapy.Electron J Metab Nutr Cancer. 2016；3(4):239-242.
11.徐惠君，杨杨，何义富.肠内营养对胃食管癌化疗患者营养状况及毒副反应的影响.肿瘤代谢与营养电子杂志. 2018；5(4):411-414.
12.李帆，李靖，田彩琴，等.肠内外营养对胃肠肿瘤化疗患者营养的毒副反应的观察.肿瘤代谢与营养电子杂志. 2018；5(1):43-47.
13.刘苏瑶，王峻，樊卫飞，等.免疫肠内营养对老年晚期肺癌化疗患者营养状况的影响.肿瘤代谢与营养电子杂志. 2017；4(2):179-184.
14.魏尉，文旭，李刚，等.免疫肠内营养对全胃切除老年患者营养及免疫调节作用.肿瘤代谢与营养电子杂志. 2017；4(2):204-207.
15.Kondrup J， Johansen N， Plum LM， et al. Incidence of nutritional risk and causes of inadequate nutritional care in hospitals.Clin Nutr. 2002； 21(6):461-468．
16.Temel JS，Greer JA， Muzikansky A， et al. Early palliative care for patients with metastatic non-small-cell lung cancer.N Engl J Med. 2010；363(8):733-742.
17.Constantinou C，Fontes de Oliveira CC， Mintzopoulos D， et al. Nuclear magnetic resonance in conjunction with functional genomics suggests mitochondrial dysfunction in a murine model of cancer cachexia.Int J Mol Med. 2011；27(1):15-24.
18.Fontes-Oliveira CC， Busquets S， Toledo M， et al. Mitochondrial and sarcoplasmic reticulum abnormalities in cancer cachexia:altered energetic efficiency. Biochim Biophys Acta. 2013；1830(3):2770-2778.
19.Tisdale MJ.Mechanisms of cancer cachexia.Physiol Rev. 2009；89(2):381-410．
20.Das SK，Hoefler G.The role of triglyceride lipases in cancer associated cachexia.Trends Mol Med.2013；19(5):292-301.
21.Kir S，White JP， Kleiner S， et al. Tumour-derived PTH-related protein triggers adipose tissue browning and cancer cachexia. Nature. 2014；513(7516):100-104.
22.Nicolini A，Ferrari P， Masoni MC， et al. Malnutrition， anorexia and cachexia in cancer patients:a mini-review on pathogenesis and treatment.Biomed Pharmacother. 2013；67(8):807-817.
23.石汉平.营养疗法应该成为肿瘤患者的基本治疗.中华结直肠疾病电子杂志. 2013；2(3):99-101.
24.Arends J，Bachmann P， Baracos V， et al.ESPEN guidelines on nutrition in cancer patients.Clin Nutr. 2017；36(1):11-48.
25.石汉平，许红霞，李苏宜，等.中国抗癌协会肿瘤营养与支持专业委员会.营养不良的五阶梯治疗.肿瘤代谢与营养电子杂志. 2015；2(1):29-33.
26.张常华.肠内免疫营养在胃肠道恶性肿瘤患者中的应用.消化肿瘤杂志. 2014；6(1):8-10.
27.Childs， D.S， Jatoi A. A hunger for hunger: a review of palliative therapies for cancer associated anorexia.Ann Palliat Med. 2019；8(1):50-58.
28.Kato T， Kolenic N， Pardini RS. Docosahexaenoic acid (DHA)， a primary tumor suppressive omega-3 fatty acid， inhibits growth of colorectal cancer independent of p53 mutational status.Nutr Cancer. 2007；58(2):178-187.
29.Sheng H，Chen X， Liu B， et al.Omega-3 polyunsaturated fatty acids enhance cisplatin efficacy in gastric cancer cells by inducing apoptosis via adora1. Anticancer Agents Med Chem. 2016；16(9):1085-1092.
30.Van Heecheren WJ， Ortiz J， Cooney MM， et al.Hypertension， proteinuria， and antagonism of vascular endothelial growth factor signaling: clinical toxicity， therapeutic target， or novel biomarker.J Clin Oncol. 2007；25(21):2993-2995.
31.Klek S，Szybinski P， Szczepanek K. Perioperative immunonutrition in surgical cancer patients：a summary of a decade of research.World J Surg. 2014；38(4):803-812．
32.谭善月，刘凌翔.肿瘤相关疲乏的诊疗.肿瘤代谢与营养电子杂志. 2018；5(3):236-239.
33.Pasqualetti V， Altomare A， Guarino MP， et al.Antioxidant activity of inulin and its role in the prevention of human colonic muscle cell impairment induced by lipopolysaccharide mucosal exposure.PLoS One. 2014；9(5):e98031
34.Bischoff SC，Barbara G， Buurman W， et al.Intestinal permeability-a new target for disease prevention and therapy.BMC Gastroenterol. 2014；14(1):189．
35.Wong C，Harris PJ， Ferguson LR.Potential benefits of dietary fibre intervention in inflammatory bowel disease. Int J Mol Sci. 2016；17(6):919．
36.马兴群，成远，陈映霞.VEGF信号通路抑制剂相关蛋白尿的研究进展.临床肿瘤学杂志. 2015；20(4):357-362．
37.McLellan B，Ciardiello F， Lacouture ME， et al.Ｒegorafenib associated hand foot skin reaction: practical advice on diagnosis， prevention， and manageme.Ann Oncol. 2015；26(10):2017-2026.
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