微生態營養學干預腫瘤惡液質的臨床對照研究

張鵬海+朱佩禎+陳銀巧+馬敏+呂宇克+李可

[摘要] 目的 研究微生態營養學干預腫瘤惡液質的臨床效果。 方法 選擇2015年6月～2016年6月期間收治的60例胃腸道腫瘤惡液質患者，研究組30例予最佳支持治療聯合益生菌治療，對照組30例僅予最佳支持治療。治療前后均測定體重，采用ELISA法檢測血清IL-6、TNF-α、IFN-γ水平，采用流式細胞儀檢測CD3+、CD4+、CD8+及NK細胞數，采用疲勞嚴重度量表（FSS）和生活質量（QOL）量表進行評估，并觀察不良反應。 結果 兩組治療后血清IL-6、 TNF-α、IFN-γ水平均顯著降低（P<0.05），組間比較差異無統計學意義（P>0.05）。對照組治療后CD3+、CD4+、CD8+及NK細胞數均無顯著變化（P>0.05），研究組CD4+、NK細胞數顯著增加（P<0.05），組間比較差異無統計學意義（P>0.05）。兩組治療后FSS積分、QOL總分均顯著改善（P<0.05），研究組QOL總分顯著優于對照組（P<0.05）；研究組體重增長值明顯多于對照組（P<0.05）。研究組不良反應發生率顯著低于對照組（P<0.05）。 結論 從微生態營養學干預腫瘤惡液質安全、有效，值得推廣與應用。

[關鍵詞] 微生態營養學；益生菌；胃腸道腫瘤；惡液質

[中圖分類號] R73 [文獻標識碼] A [文章編號] 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

惡液質存在于大多數（>80%）晚期癌癥患者身上，近20%腫瘤患者直接死于惡液質，其中胃腸道腫瘤惡液質更為常見[1]。目前惡液質的定義尚不明確，一般認為是機體的綜合性代謝變化過程， 以體重下降為最常見的癥狀表現，其它還包括厭食、疲勞、貧血、脂解作用增強、骨骼肌分解代謝增加而蛋白合成代謝減少等，同時很多患者常伴隨病灶局部疼痛，且血液學、生化以及免疫指標均出現大幅偏離異常[2]。近年來我們已經對腫瘤惡液質機制及治療方面做一些初步的研究，并發現炎癥因子C反應蛋白（creactive protein，CRP）、白介素-6（interleukin-6，IL-6）、α腫瘤壞死因子（tumor necrosis factor-α，TNF-α）和γ-干擾素（interferon-γ，IFN-γ）在癌癥惡液質患者中升高明顯，可能是癌性惡液質過程的重要細胞因子，提示炎癥與惡液質之間的密切關系[3]。因此通過抑制或者調控非特異性炎癥可能是控制惡液質發生和發展的有效手段。近年研究表明，益生菌（probiotics）有糾正宿主腸道內菌群紊亂的作用，有益于促進機體特異或非特異性免疫增強，從而改善機體免疫系統[2-4]。為此，本研究從微生態營養學的角度對胃腸道腫瘤惡液質患者進行了干預，現報道如下。