高蛋白配方与标准肠外营养在癌症姑息治疗中的比较。

High-protein compared with standard parenteral nutrition in palliative cancer care.

机构信息

Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.

Palliative Home Care and Hospice Ward, ASIH Stockholm Södra, Älvsjö, Sweden.

出版信息

BMJ Support Palliat Care. 2022 Sep;12(3):332-338. doi: 10.1136/bmjspcare-2019-002139. Epub 2020 May 25.

DOI:10.1136/bmjspcare-2019-002139

PMID:32451328

Abstract

OBJECTIVES

High-protein parenteral nutrition (PN) has been developed to counteract muscle loss in patients with cancer treated with PN. Nevertheless, it is not clear if high-protein PN is as safe as standard PN in patients with palliative cancer. Our primary aim was to compare the proportion of patients with elevated liver enzymes between high-protein and standard PN in patients with palliative cancer enrolled to Medical Home Care. Our secondary aim was to compare the two treatments with regard to weight and albumin levels during treatment.

METHODS

Medical records from 2016 to 2018 were retrospectively reviewed to identify palliative cancer patients that had received PN for more than 3 weeks. Data on weight, height, albumin, liver enzymes, socioeconomic factors and dietitian consultations were collected at baseline and after 3-8 weeks of PN treatment. The odds of having elevated liver enzymes or having a maintained weight and/or stable albumin levels were calculated using logistic regression.

RESULTS

20 patients treated with high-protein PN were compared with 104 patients treated with standard PN. Patients treated with high-protein PN had a significantly higher weight at follow-up compared with patients treated with standard PN (p<0.05). There was no significant difference in the proportion of patients with elevated liver enzymes (OR 0.20; 95% CI 0.02 to 1.86), or maintained weight and/or albumin levels (OR 1.62; 95% CI 0.46 to 5.76) between high-protein and standard PN.

CONCLUSION

High-protein PN was as safe, and at least as effective, as standard PN to patients with palliative cancer.

摘要

目的

高蛋白质肠外营养（PN）旨在抵消接受 PN 治疗的癌症患者的肌肉损失。然而，在姑息治疗的癌症患者中，高蛋白质 PN 是否与标准 PN 一样安全尚不清楚。我们的主要目的是比较纳入家庭医疗保健的姑息治疗癌症患者中，高蛋白质 PN 和标准 PN 之间肝酶升高的患者比例。我们的次要目的是比较两种治疗方法在治疗期间的体重和白蛋白水平。

方法

回顾性分析 2016 年至 2018 年的病历，以确定接受 PN 治疗超过 3 周的姑息治疗癌症患者。在基线和 PN 治疗 3-8 周后收集体重、身高、白蛋白、肝酶、社会经济因素和营养师咨询的数据。使用逻辑回归计算肝酶升高或维持体重和/或稳定白蛋白水平的几率。

结果

将 20 例接受高蛋白质 PN 治疗的患者与 104 例接受标准 PN 治疗的患者进行比较。与接受标准 PN 治疗的患者相比，接受高蛋白质 PN 治疗的患者在随访时体重明显增加（p<0.05）。肝酶升高（OR 0.20；95%CI 0.02 至 1.86）或维持体重和/或白蛋白水平（OR 1.62；95%CI 0.46 至 5.76）的患者比例在高蛋白质和标准 PN 之间没有显著差异。