Rickard K A, Godshall B J, Loghmani E S, Coates T D, Grosfeld J L, Weetman R M, Lingard C D, Foland B B, Yu P L, McGuire W
Department of Pediatric Nutrition and Dietetics, James Whitcomb Riley Hospital for Children, Indianapolis, IN 46223.
Cancer. 1989 Jul 15;64(2):491-509. doi: 10.1002/1097-0142(19890715)64:2<491::aid-cncr2820640224>3.0.co;2-y.
Benefits and risks of nutrition support were evaluated in 31 malnourished children with newly diagnosed Wilms' tumor managed according to the third National Wilms' Tumor Study protocol. Patients were classified at diagnosis as being at high nutritional risk (HNR, n = 19) or low nutritional risk (LNR, n = 12). Ten HNR patients were randomized to central parenteral nutrition (CPN) and nine HNR patients were randomized to peripheral parenteral nutrition (PPN) plus enteral nutrition (EN) for 4 weeks of initial intense treatment and EN (nutritional counseling, oral foods and supplements) thereafter. Thirteen HNR patients (seven CPN, six PPN) completed the protocol. Twelve LNR patients received EN; 11 Stage I malnourished patients were randomized to 10 or 26 weeks of chemotherapy. Dietary, anthropometric, and biochemical data were determined for HNR patients at weeks 0-4, 6, 13, 19, and 26 and for LNR patients at weeks 1, 2, 5, and 26. In HNR patients, adequate parenteral nutrition support reversed protein energy malnutrition (PEM), and prevented chemotherapy and radiotherapy delays due to granulocytopenia. CPN was superior to PPN in reversing PEM: energy intake, weight gain, and retinol binding protein were higher (P less than 0.05). LNR patients lost weight and fat reserves in the first 2 weeks of treatment; depletion persisted at week 5, and 25% had chemotherapy delays. Thereafter, EN reversed PEM in patients with both chemotherapy regimens. These data suggest that CPN is preferable during initial intense treatment for HNR patients, and that, although EN is ineffective in preventing depletion and treatment delays in the first 5 weeks of treatment for LNR patients, it is effective thereafter.
根据第三届全国肾母细胞瘤研究方案，对31例新诊断为肾母细胞瘤的营养不良儿童的营养支持的益处和风险进行了评估。患者在诊断时被分为高营养风险（HNR，n = 19）或低营养风险（LNR，n = 12）。10例HNR患者被随机分配接受中心静脉营养（CPN），9例HNR患者被随机分配接受外周静脉营养（PPN）加肠内营养（EN），为期4周的初始强化治疗，此后接受EN（营养咨询、口服食物和补充剂）。13例HNR患者（7例CPN，6例PPN）完成了该方案。12例LNR患者接受了EN；11例I期营养不良患者被随机分配接受10周或26周的化疗。在第0 - 4、6、13、19和26周测定了HNR患者的饮食、人体测量和生化数据，在第1、2、5和26周测定了LNR患者的相关数据。在HNR患者中，充足的肠外营养支持逆转了蛋白质能量营养不良（PEM），并防止了因粒细胞减少导致的化疗和放疗延迟。在逆转PEM方面，CPN优于PPN：能量摄入、体重增加和视黄醇结合蛋白更高（P < 0.05）。LNR患者在治疗的前2周体重和脂肪储备减少；在第5周时消耗持续存在，25%的患者出现化疗延迟。此后，EN逆转了两种化疗方案患者的PEM。这些数据表明，对于HNR患者，在初始强化治疗期间CPN更可取，并且，尽管EN在LNR患者治疗的前5周预防消耗和治疗延迟方面无效，但此后是有效的。
