目的 分析基于中链甘油三酯(MCT)的生酮饮食在接受化疗 3 个月以上的乳腺癌患者中的应用价值。 方法 选取武 汉市第三医院 2021 年 3 月至 2023 年 3 月期间入院的乳腺癌患者(接受化疗干预 3 个月以上)120 例,简单随机将其分为对照 组(60 例)、干预组(60 例)。 其中,对照组接受传统化疗饮食干预,干预组接受基于 MCT 的生酮饮食干预,两组患者均实施为 期 5 周的临床观察。 比较两组患者干预前、干预 1 周、2 周、3 周、5 周血酮、血糖及体重情况。 同时,比较两组患者炎症指标[C 反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白介素-1β(IL-1β)]、免疫指标(CD3 + 、CD4 + 、CD8 + T 细胞)、肠道门水平优势菌群 (厚壁菌门、拟杆菌门、变型菌门)、不良反应(恶心、呕吐、腹泻、便秘)、低血糖发生率差异。 结果 干预 1 周至 5 周,干预组血 酮水平较干预前升高,且干预组血酮水平高于对照组[(1. 84±0. 12) mmol / L 比(0. 41±0. 10) mmol / L]、[(2. 10±0. 11) mmol / L 比(0. 42±0. 09) mmol / L]、[(2. 01±0. 15) mmol / L 比(0. 44±0. 10) mmol / L]、[(2. 00±0. 19) mmol / L 比(0. 43±0. 08) mmol / L] (P<0. 05)。 干预 1 周至 5 周,干预组血糖水平较干预前升高,且干预组血糖水平低于对照组(P<0. 05)。 干预 5 周,与干预前 相比,两组患者体重均下降(P< 0. 05)。 干预后,干预组 CD3 + 、CD4 + T 细胞占比高于对照组[( 70. 15± 6. 07)% 比( 57. 62± 5. 09)%]、[(54. 02±5. 62) % 比(43. 06±4. 98)%],CD8 + T 细胞占比[(30. 62±3. 45)% 比(35. 62±3. 11)%]、炎症指标低于对 照组(P<0. 05)。 干预后,两组患者厚壁菌门、变型菌门丰度均较干预前下降,拟杆菌门较干预前上升,且干预组拟杆菌门丰度 高于对照组,厚壁菌门、变型菌门丰度低于对照组(P<0. 05)。 干预组不良反应总发生率( 13. 33%,8 / 60) 显著低于对照组 (31. 67%,19 / 60)(P<0. 05)。 结论 对接受化疗 3 个月以上的乳腺癌患者而言,基于 MCT 的生酮饮食干预可改善患者的整体健康状况、减少化疗的不良反应等,生酮饮食治疗乳腺癌过程安全、可行,可为临床乳腺癌化疗及不良反应改善提供参考。

Objective To analyze the application value of medium-chain triglyceride MCT based ketogenic diet in breast cancer patients receiving chemotherapy for more than 3 months. Method A total of 120 patients with breast cancer receiving chemotherapy intervention for more than 3 months were enrolled in the Oncology Department of Wuhan Third Hospital from March 2021 to March 2023 and were simply randomly divided into control group n = 60 and intervention group n = 60 . Among them the control group received traditional chemotherapy diet intervention and the intervention group received MCT-based ketogenic diet intervention. Both groups were subjected to clinical observation for 5 weeks. Blood ketone blood glucose and body weight of the two groups were compared before intervention after 1 2 3 and 5 weeks of intervention. Meanwhile the inflammatory indexes CRP TNF - α interleukin- 1β immune indexes CD3 + CD4 + CD8 + and the dominant bacteria group of intestinal hilum Firmicutes Bacteroidetes and Morphomycetes were compared between the two groups. The incidence of variant bacteria adverse reactions nausea vomiting diarrhea constipation and hypoglycemia were different. Result After 1 to 5 weeks of intervention blood ketone levels in the intervention group were higher than before intervention. Moreover the blood ketone in the intervention group was higher than that in the control group 1. 84±0. 12 mmol / L vs 0. 41±0. 10 mmol / L 2. 10±0. 11 mmol / L vs 0. 42±0. 09 mmol / L 2. 01±0. 15 mmol / L vs 0. 44±0. 10 mmol / L 2. 00±0. 19 mmol / L vs 0. 43±0. 08 mmol / L P<0. 05 . After 1 to 5 weeks of intervention the blood glucose level in the intervention group was higher than before intervention and the blood glucose level in the intervention group was lower than that in the control group P<0. 05 . After 5 weeks of intervention body weight decreased in both groups compared with before intervention P<0. 05 . After intervention CD3 + and CD4 + in the intervention group were higher than those in the control group 70. 15 ± 6. 07 mmol / L vs 57. 62 ± 5. 09 % and 54. 02 ± 5. 62 % vs 43. 06 ± 4. 98 % . CD8 + 30. 62±3. 45 % vs 35. 62±3. 11 % and inflammation index were lower than control group P<0. 05 . After the intervention the abundances of Firmicutes and Morphomycetes in both groups decreased and Bacteroidetes increased and the abundances of Bacteroidetes in the intervention group was higher than those in the control group while those in the Firmicutes and variant Morphomycetes were lower than those in the control group P<0. 05 . The total incidence of adverse reactions in the intervention group 13. 33% 8 / 60 was significantly lower than that in the control group 31. 67% 19 / 60 P<0. 05 . Conclusion For breast cancer patients who have received chemotherapy for more than 3 months ketogenic diet intervention based on MCT can improve the overall health status of patients and reduce the side effects of chemotherapy etc. Ketogenic diet treatment of breast cancer is safe and feasible and can provide references for clinical breast cancer chemotherapy treatment and improvement of adverse reactions.