早期补充肠外营养对晚期癌症患者生活质量和身体组成的影响。

The influence of early supplementation of parenteral nutrition on quality of life and body composition in patients with advanced cancer.

作者信息

Shang Edward, Weiss Christel, Post Stefan, Kaehler Georg

机构信息

Department of Surgery, University Hospital Mannheim, Germany.

出版信息

JPEN J Parenter Enteral Nutr. 2006 May-Jun;30(3):222-30.

PMID:16639069

Abstract

BACKGROUND

According to current evidence, most organizations, including the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), do not recommend the routine use of artificial nutrition for patients with cancer. Despite the recommendation for parenteral nutrition (PN), data for early PN supplementation (PNS) in patients with an advanced malignancy are extremely limited, especially in terms of the affects on nutrition outcomes, body composition, and quality of life (QOL), as well as effects on oncologic outcomes. The aim of the study was to evaluate the effect of PNS on body composition and the quality of life in patients with advanced malignancies.

METHODS

One hundred fifty-two consecutive patients with advanced cancer were prospectively randomized to either use of oral enteral nutrition supplement (PN-) or use of oral enteral nutrition supplement plus supplemental PN (PN+). Body weight, body mass index (BMI), and caloric intake were assessed, and hemoglobin (g/dL) and serum albumin (g/L) were measured. Body composition was assessed by body impedance analysis (BIA), and QOL was evaluated by European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire every 6 weeks.

RESULTS

No significant differences were evident at baseline between the 2 groups for age, gender, medical diagnosis, weight, BMI, or QOL. A statistically significant difference in mean BMI was observed by week 48 for the PN+ group (PN+ = 21.9, PN-= 20.5, p = .0149), by week 6 in mean body cell mass (PN+ = 55%, PN-= 50,1%, p < .001), mean albumin (PN+ = 40.2 g/L, PN-= 36.2 g/L, p = .015), mean QOL (PN+ = 55.7, PN-= 50.9, p = .035). The cumulative survival rate was significantly greater in the PN+ group (p < .0001).

CONCLUSIONS

According to the positive effect of supplemental PN on survival, body composition, and QOL, additional controlled studies must be conducted to confirm these findings.

摘要

背景

根据现有证据，包括美国肠外和肠内营养学会（A.S.P.E.N.）在内的大多数组织都不建议对癌症患者常规使用人工营养。尽管推荐了肠外营养（PN），但晚期恶性肿瘤患者早期补充肠外营养（PNS）的数据极为有限，尤其是在对营养结局、身体成分和生活质量（QOL）的影响以及对肿瘤学结局的影响方面。本研究的目的是评估PNS对晚期恶性肿瘤患者身体成分和生活质量的影响。

方法

152例连续的晚期癌症患者被前瞻性随机分为口服肠内营养补充剂组（PN-）或口服肠内营养补充剂加补充性PN组（PN+）。评估体重、体重指数（BMI）和热量摄入，并测量血红蛋白（g/dL）和血清白蛋白（g/L）。通过人体阻抗分析（BIA）评估身体成分，每6周通过欧洲癌症研究与治疗组织（EORTC）QLQ-C30问卷评估QOL。

结果

两组在年龄、性别、医学诊断、体重、BMI或QOL方面，基线时无明显差异。PN+组在第48周时平均BMI有统计学显著差异（PN+ = 21.9，PN- = 20.5，p = 0.0149），在第6周时平均身体细胞质量有差异（PN+ = 55%，PN- = 50.1%，p < 0.001），平均白蛋白有差异（PN+ = 40.2 g/L，PN- = 36.2 g/L，p = 0.015），平均QOL有差异（PN+ = 55.7，PN- = 50.9，p = 0.035）。PN+组的累积生存率显著更高（p < 0.0001）。