术后mFOLFOX4化疗方案对胃肠道肿瘤患者营养状况及免疫功能的影响

摘要

目的 观察mFOLFOX4(奥沙利铂、亚叶酸钙、氟尿嘧啶联合化疗)化疗方案对围化疗期胃肠道肿瘤患者营养状况及免疫功能的影响.方法 收集2012年5月至2014年2月期间于山东省滨州市中心医院诊断为胃肠道恶性肿瘤术后化疗患者45例,均采用mFOLFOX4方案进行化疗.于化疗前和化疗6个周期后通过患者自评主观全面评定量表(PG-SGA)评分、欧洲营养风险筛查2002(NRS-2002)评分、体格测量及实验室检测进行营养评价,检测T细胞亚群(CD4+、CD8、CD4+/CD8+),观察化疗后并发症、平均住院时间.结果 化疗前营养良好者18例(40.0％),轻、中度营养不良20例(44.4％),重度营养不良7例(15.6％);化疗后营养良好5例(11.1％),轻、中度营养不良30例(66.7％)、重度营养不良10例(22.2％).化疗后营养不良者占比高于化疗前(P＜0.01).化疗前有营养风险者19例(42.2％),化疗后有营养风险者30例(66.7％),化疗后有营养风险者占比高于化疗前(P＜0.05).化疗后血红蛋白、前白蛋白、白蛋白、体重指数明显低于化疗前,差异有统计学意义[(112±21) g/L比(121±23) g/L、(226±93) mg/L比(248±107) mg/L、(35±8)g/L比(39±8)g/L、(22±3)kg/m2比(23 ±3) kg/m2] (P ＜0.01),PG-SGA评分和NRS-2002评分化疗后无明显变化,差异无统计学意义[(6±2)分比(5±2)分、(3±2)分比(3±2)分](P＞0.05).化疗后CD4+/CD8+ T细胞明显下降(1.04 ±0.26比1.16±0.19),差异有统计学意义(P＜0.05).PG-SGA评分与血红蛋白、前白蛋白、白蛋白、体重指数、三头肌皮肤折叠厚度(TSF)、上臂中段肌肉周长(MAMC)呈负相关(r值分别为-0.295、-0.228、-0.534、-0.306、-0.276、-0.279,均P＜0.05).NRS-2002评分分别与血红蛋白、前白蛋白、白蛋白、体重指数、TSF、MAMC呈负相关(r值分别为-0.431、-0.423、-0.667、-0.384、-0.489、-0.409,均P＜0.05),与PG-SGA呈正相关(r=0.789,P＜0.05).结论 mFOLFOX4方案可增加围化疗期胃肠道肿瘤患者营养不良的发生率,且对免疫功能有明显的抑制作用,应加强围化疗期胃肠道肿瘤患者的营养补充,合理搭配膳食,并增强患者免疫功能,预防感染等相关并发症.%Objective To observe the effect of mFOLFOX4 chemotherapy regimen on nutritional status and immune function in patients with gastrointestinal neoplasms.Methods Totally 45 patients with gastrointestinal neoplasms receiving mFOLFOX4 chemotherapy regimen from May 2012 to February 2014 were collected.After 6 cycles of chemotherapy,the patient-generated subjective global assessment (PG-SGA) score,nutritional risk screening (NRS-2002) score,anthropometric and laboratory detection were applied to assess the nutrition situation;the T cell subsets (CD4+,CD8+,CD4+/CD8+) in the peripheral blood were measured to evaluate the immune function.The with the PG-SGA score as the nutritional index,respectively.The complications after chemotherapy and average hospitalization time were observed.Results Before chemotherapy,there were 18 cases (40.0％) of good nutrition,20 cases (44.4％) of mild to moderate malnutrition and 7 cases (15.6％) of severe malnutrition;after chemotherapy,there were 5 cases (11.1％) of good nutrition,30 cases (66.7％) of mild to moderate malnutrition and 10 cases (22.2％) of severe malnutrition.The proportion of malnutrition after chemotherapy was significantly higher compared with that before treatment (P ＜ 0.01).The proportion of patients with nutritional risk after chemotherapy was significantly increased compared with that before treatment [66.7％ (30/45) vs 42.2％ (19/45),P ＜ 0.05].After chemotherapy,the hemoglobin,prealbumin,albumin and body mass index were significantly reduced [(112 ±21) g/L vs (121 ±23) g/L,(226 ±93) mg/L vs (248 ± 107) mg/L,(35 ± 8) g/L vs (39 ± 8) g/L,(22 ± 3) kg/m2 vs (23 ± 3) kg/m2] (P ＜ 0.05);PG-SGA and NRS-2002 scores had no significant changes after chemotherapy [(6 ± 2) scores vs (5 ± 2) scores,(3 ± 2) scores vs (3 ± 2) scores] (P ＞0.05).The ratio of CD4+/CD8+ T cells was significantly reduced after chemotherapy (1.04 ± 0.26 vs 1.16 ±0.19,P ＜ 0.05).PG-SGA score was negatively correlated with hemoglobin,prealbumin,albumin,body mass index,triceps skin fold (TSF),mid-arm muscle circumference (MAMC),(r =-0.295,-0.228,-0.534,-0.306,-0.276,-0.279,all P ＜ 0.05).NRS-2002 score was negatively correlated with hemoglobin,albumin,pre albumin,body mass index,TSF,MAMC (r =-0.431,-0.423,-0.667,-0.384,-0.489,-0.409,all P ＜ 0.05),and it was positively correlated with PG-SGA score (r =0.789,P ＜ 0.05).Conclusion mFOLFOX4 chemotherapy regimen increases the incidence of malnutrition in gastrointestinal cancer patients and has obvious inhibitory effect on immune function.