微生态营养学干预肿瘤恶液质的临床对照研究

张鹏海+朱佩祯+陈银巧+马敏+吕宇克+李可

[摘要] 目的 研究微生态营养学干预肿瘤恶液质的临床效果。 方法 选择2015年6月～2016年6月期间收治的60例胃肠道肿瘤恶液质患者，研究组30例予最佳支持治疗联合益生菌治疗，对照组30例仅予最佳支持治疗。治疗前后均测定体重，采用ELISA法检测血清IL-6、TNF-α、IFN-γ水平，采用流式细胞仪检测CD3+、CD4+、CD8+及NK细胞数，采用疲劳严重度量表（FSS）和生活质量（QOL）量表进行评估，并观察不良反应。 结果 两组治疗后血清IL-6、 TNF-α、IFN-γ水平均显著降低（P<0.05），组间比较差异无统计学意义（P>0.05）。对照组治疗后CD3+、CD4+、CD8+及NK细胞数均无显著变化（P>0.05），研究组CD4+、NK细胞数显著增加（P<0.05），组间比较差异无统计学意义（P>0.05）。两组治疗后FSS积分、QOL总分均显著改善（P<0.05），研究组QOL总分显著优于对照组（P<0.05）；研究组体重增长值明显多于对照组（P<0.05）。研究组不良反应发生率显著低于对照组（P<0.05）。 结论 从微生态营养学干预肿瘤恶液质安全、有效，值得推广与应用。

[关键词] 微生态营养学；益生菌；胃肠道肿瘤；恶液质

[中图分类号] R73 [文献标识码] A [文章编号] 1673-9701（2017）07-0008-04

[Abstract] Objective To research the effect of micro ecological nutrition intervene in malignant tumor fluid. Methods 60 cases of patients with gastrointestinal cancer dyscrasia from Junn 2015 to June 2016 were collected，the research group with 30 cases were treated with the best supportive therapy combined with probiotics，and the control group with 30 cases were only treated with the best support.Weight were measured，and the levels of serum IL-6， TNF-α and IFN-γ were detected by ELISA method，and cell number of CD3+， CD4+， CD8+ and NK were detected by flow cytometry，and were evaluated by fatigue severity scale （FSS） and quality of life （QOL） scale before and after treatment，and adverse reactions were observed. Results After treatment， the serum levels of IL-6， TNF-α and IFN-γ were significantly decreased after treatment of two groups （P<0.05），and there were no statistical significance between the two groups （P>0.05）.There were no significant change in the number of CD3+， CD4+， CD8+ and NK cells of the control group after treatment （P>0.05），and the number of CD4+ and NK cells were significantly increased of the research group （P<0.05），and there were no statistical significance between the two groups（P>0.05）.The scores of FSS and QOL were significantly improved of the two groups （P<0.05），and the QOL total score in the research group was significantly better than that of the control group （P<0.05）.The weight gain of the research group was significantly higher than that of the control group（P<0.05）.The incidence of adverse reactions of the research group was significantly lower than that in the control group（P<0.05）. Conclusion Micro ecological nutrition intervene in tumor dyscrasia is safe and effective，which is worthy of popularization and application.

[Key words] Micro ecological nutrition； Probiotics； Gastrointestinal neoplasms； Dyscrasia

恶液质存在于大多数（>80%）晚期癌症患者身上，近20%肿瘤患者直接死于恶液质，其中胃肠道肿瘤恶液质更为常见[1]。目前恶液质的定义尚不明确，一般认为是机体的综合性代谢变化过程， 以体重下降为最常见的症状表现，其它还包括厌食、疲劳、贫血、脂解作用增强、骨骼肌分解代谢增加而蛋白合成代谢减少等，同时很多患者常伴随病灶局部疼痛，且血液学、生化以及免疫指标均出现大幅偏离异常[2]。近年来我们已经对肿瘤恶液质机制及治疗方面做一些初步的研究，并发现炎症因子C反应蛋白（creactive protein，CRP）、白介素-6（interleukin-6，IL-6）、α腫瘤坏死因子（tumor necrosis factor-α，TNF-α）和γ-干扰素（interferon-γ，IFN-γ）在癌症恶液质患者中升高明显，可能是癌性恶液质过程的重要细胞因子，提示炎症与恶液质之间的密切关系[3]。因此通过抑制或者调控非特异性炎症可能是控制恶液质发生和发展的有效手段。近年研究表明，益生菌（probiotics）有纠正宿主肠道内菌群紊乱的作用，有益于促进机体特异或非特异性免疫增强，从而改善机体免疫系统[2-4]。为此，本研究从微生态营养学的角度对胃肠道肿瘤恶液质患者进行了干预，现报道如下。