本文選題：消化道惡性腫瘤 + 化療　； 參考：《北京協(xié)和醫(yī)學(xué)院》2015年博士論文

【摘要】：研究目的：研究補(bǔ)充谷氨酰胺、EPA、支鏈氨基酸對(duì)食管癌同步放化療及胃癌術(shù)后輔助化療患者的作用。研究方法：前瞻性隨機(jī)對(duì)照研究。入組患者選擇：自2013年4月至2014年4月因食管癌、胃癌在中國(guó)醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院及桓興病區(qū)內(nèi)科、放療科住院擬行同步化放療或化療的患者104例,符合入組標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),并自愿參加研究,其中食管癌同步放化療患者48例,胃癌術(shù)后輔助化療患者56例。隨機(jī)入組：使用隨機(jī)數(shù)字表法,將患者按病種不同分別隨機(jī),分為2組：試驗(yàn)組和對(duì)照組,各52例。干預(yù)方法：兩組的抗腫瘤治療手段相同,營(yíng)養(yǎng)干預(yù)均在營(yíng)養(yǎng)支持小組的管理下,兩組均進(jìn)行膳食指導(dǎo)及常規(guī)營(yíng)養(yǎng)支持,試驗(yàn)組在膳食指導(dǎo)及常規(guī)營(yíng)養(yǎng)支持的基礎(chǔ)上給予補(bǔ)充谷氨酰胺(20 g/d)、EPA (3.3 g/d)、支鏈氨基酸(8 g/d),對(duì)照組不進(jìn)行額外補(bǔ)充谷氨酰胺、EPA、支鏈氨基酸。評(píng)價(jià)：食管癌放化療結(jié)束、胃癌3周期化療結(jié)束時(shí),比較治療前后兩組患者人體成分分析結(jié)果、部分血液學(xué)指標(biāo)、并發(fā)癥發(fā)生率、治療完成率。同時(shí)采用歐洲癌癥研究與治療組織(European Organisation for Research and Treatment of Cancer, EORTC)制訂的用于測(cè)評(píng)癌癥生命質(zhì)量的專用量表EORTC QLQ-C30主量表及子量表EORTC QLQ-OES18,對(duì)治療前后的食管癌、胃癌患者生命質(zhì)量各維度指標(biāo)進(jìn)行測(cè)評(píng)。按照EORTC QLQ評(píng)分標(biāo)準(zhǔn)對(duì)兩組患者的生命質(zhì)量維度指標(biāo)結(jié)果進(jìn)行調(diào)查,功能維度得分越高,功能越好；癥狀維度得分越高,癥狀越重。研究結(jié)果：人體成分分析結(jié)果：試驗(yàn)組治療前后體重穩(wěn)定(0.46±2.19,p0.05),而對(duì)照組體重顯著下降(-2.52±2.57,p0.05)；試驗(yàn)組非脂組織重量(1.40±2.33,p0.05)及骨骼肌重量(0.98±3.09,p0.05)均顯著增加,而對(duì)照組顯著降低(p0.05)。部分血液指標(biāo)：試驗(yàn)組血白蛋白、紅細(xì)胞、白細(xì)胞、血小板保持穩(wěn)定(p0.05),而對(duì)照組均顯著下降(p0.05)。感染相關(guān)并發(fā)癥發(fā)生率：試驗(yàn)組低于對(duì)照組(6% vs 19%),差異有顯著意義(p0.05)。試驗(yàn)組按治療計(jì)劃完成率顯著高于對(duì)照組(96% vs 83%,p0.05)。治療后的試驗(yàn)組患者在胃食管返流癥狀、疼痛、綜合生命質(zhì)量維度等方面得分優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義。但在癥狀性維度及其他功能指標(biāo)得分兩組患者之間的差別無(wú)統(tǒng)計(jì)學(xué)意義。兩組患者的癥狀性指標(biāo)均較治療前明顯升高,功能性指標(biāo)均比治療前降低,說(shuō)明患者的生活質(zhì)量在放化療后有所降低,生活質(zhì)量受到放化療的影響。結(jié)論：對(duì)于食管癌同步放化療及胃癌術(shù)后輔助化療患者,在常規(guī)膳食指導(dǎo)及營(yíng)養(yǎng)支持中補(bǔ)充谷氨酰胺、EPA、支鏈氨基酸有利于維持患者的營(yíng)養(yǎng)狀況、降低并發(fā)癥發(fā)生率、提高患者的治療順應(yīng)性,與未補(bǔ)充的患者相比可提高其生活質(zhì)量。
[Abstract]:Objective: to study the effects of supplementation of Glutamine EPA and branched-chain amino acids on concurrent radiotherapy and chemotherapy for esophageal carcinoma and postoperative adjuvant chemotherapy for gastric cancer. Methods: prospective randomized controlled trial. Selection of patients: from April 2013 to April 2014, 104 patients with esophageal cancer and gastric cancer were admitted to Huanxing Department of Internal Medicine, Huanxing Hospital of Chinese Academy of Medical Sciences. The patients in the department of radiotherapy were scheduled to undergo concurrent chemotherapy or radiotherapy, which met the criteria of admission and exclusion. There were 48 patients with esophageal carcinoma and 56 patients with adjuvant chemotherapy after operation. The patients were randomly divided into two groups: experimental group (n = 52) and control group (n = 52). Intervention methods: the two groups had the same anti-tumor therapy. The nutrition intervention was managed by the nutrition support group. The two groups were given dietary guidance and routine nutrition support. On the basis of dietary guidance and routine nutritional support, the experimental group was given 20 g / d of glutamine and 3. 3 g / d ~ (-1) of EPA, 8 g / d ~ (-1) of branched amino acids, while the control group was not given additional supplementation of Glutamine (EPA) and branched chain amino acid (BCAA). Evaluation: at the end of radiotherapy and chemotherapy for esophageal carcinoma and the end of 3-cycle chemotherapy for gastric cancer, the results of human component analysis, some hematological indexes, the incidence of complications and the completion rate of treatment were compared between the two groups before and after treatment. At the same time, the European Organization for Research and treatment of Cancer (Organisation for Research and Treatment of Cancer, EORTC) was used to evaluate the quality of life of cancer. The main and sub-scales EORTC QLQ-OES18 were used to evaluate esophageal cancer before and after treatment. The quality of life (QOL) of gastric cancer patients was evaluated. According to the EORTC QLQ score, the quality of life dimension of the two groups were investigated. The higher the score of functional dimension, the better the function, and the higher the score of symptom dimension, the more serious the symptom. Results: the results of human component analysis showed that the body weight of the experimental group was stable (0.46 鹵2.19) and that of the control group was significantly lower than that of the control group (P < 0.05). The weight of non-fat tissue and skeletal muscle in the test group were significantly increased, and the weight of non-fat tissue and skeletal muscle were increased significantly, while that of the control group was significantly lower than that of the control group (1.40 鹵2.33) and 0.98 鹵3.09 p0.05, respectively. Some blood indexes: serum albumin, red blood cell, white blood cell and platelets remained stable in the test group, while in the control group, the serum albumin, red blood cell, white blood cell and platelets decreased significantly. The incidence of infection related complications in the trial group was 6% lower than that in the control group (P 0.05). The completion rate of treatment plan in the trial group was significantly higher than that in the control group (96% vs 83%, p 0.05). The scores of gastroesophageal reflux symptoms, pain, comprehensive quality of life dimension in the trial group were better than those in the control group after treatment, and the difference was statistically significant. However, there was no significant difference between the two groups in the score of symptomatic dimension and other functional indicators. The symptom indexes of the two groups were significantly higher than those before treatment, and the functional indexes were lower than those before treatment, indicating that the quality of life of the patients decreased after radiotherapy and chemotherapy, and the quality of life was affected by radiotherapy and chemotherapy. Conclusion: for patients with esophageal cancer treated by concurrent radiotherapy and chemotherapy and adjuvant chemotherapy after gastric cancer surgery, supplementation of Glutamine EPA in routine dietary guidance and nutritional support is beneficial to maintain nutritional status of patients and reduce the incidence of complications. Improve the patient's therapeutic compliance and improve their quality of life as compared with those without supplementation.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R735

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