Ching N, Grossi C, Jham G, Angers J, Zurawinsky H, Ching C Y, Nealon T F
Surgery. 1984 Jun;95(6):730-8.
The deficits in plasma amino acids and serum unesterified fatty acids of cancer patients undergoing chemotherapy and/or radiation therapy were studied to delineate the special requirements of the patients and efficacy of our nutritional therapy. Seven general surgery patients and 13 patients treated by the Head-Neck Service had baseline levels measured as part of their nutritional evaluation prior to surgical treatment of their cancers. Fifteen chemotherapy outpatients maintained on their regular diets had fasting levels analyzed. Twenty-six patients who were admitted for their therapy had their intake of the regular hospital diet supplemented with a low-residue enteral diet formula (Vivonex High Nitrogen Diet); parenteral nutrition was used only if their oral intake was totally inadequate. Baseline and sequential measurements were made of plasma amino acid and serum unesterified fatty acid levels by gas liquid chromatographic techniques. Before operation the patients had normal levels of amino acids except for a significant deficiency of threonine and glycine observed in patients with head-neck tumors. Outpatients with and without hepatic metastases had significantly depressed levels of the essential amino acids valine, leucine, threonine, and methionine and the nonessential amino acids serine, glycine, and proline. The baseline levels of the patients admitted for treatment had similar deficiencies except for more evidence of lysine deficiency. Patients supported with total parenteral nutrition had rapid elevation of the amino acid levels. The patients whose intake was supplemented with the oral diets had improvement in their amino acid levels, but the deficiency in the leucine and threonine fractions persisted up to 4 weeks of therapy. Although the lysine levels were normal when first analyzed, significant differences developed in the patients without hepatic metastases after the start of chemotherapy with return to normal only after chemotherapy was discontinued. Fatty acid levels were not significantly different between the cancer groups except for preoperative elevated oleic acid levels noted in the general surgery tumor group; there were no deficiencies in the essential fatty acids. These studies indicate a need for enteral formulas with adequate branched-chain amino acids and enrichment with threonine and lysine for supplementing the nutrition of the cancer patient who is undergoing chemotherapy.
研究了接受化疗和/或放疗的癌症患者血浆氨基酸和血清未酯化脂肪酸的缺乏情况，以明确患者的特殊营养需求以及我们营养治疗的效果。7名普通外科患者和13名头颈部疾病科治疗的患者在癌症手术治疗前，作为营养评估的一部分进行了基线水平测量。15名维持常规饮食的化疗门诊患者进行了空腹水平分析。26名因治疗入院的患者，其常规医院饮食摄入量补充了低渣肠内饮食配方（Vivonex高氮饮食）；仅在口服摄入量完全不足时才使用肠外营养。采用气液色谱技术对血浆氨基酸和血清未酯化脂肪酸水平进行基线和连续测量。手术前，患者的氨基酸水平正常，但头颈部肿瘤患者中观察到苏氨酸和甘氨酸明显缺乏。有和没有肝转移的门诊患者，其必需氨基酸缬氨酸、亮氨酸、苏氨酸和蛋氨酸以及非必需氨基酸丝氨酸、甘氨酸和脯氨酸水平均显著降低。入院治疗患者的基线水平有类似的缺乏情况，只是赖氨酸缺乏的证据更多。接受全肠外营养支持的患者氨基酸水平迅速升高。口服饮食补充摄入量的患者氨基酸水平有所改善，但亮氨酸和苏氨酸部分的缺乏持续到治疗4周。虽然最初分析时赖氨酸水平正常，但在无肝转移的患者中，化疗开始后出现了显著差异，仅在化疗停止后才恢复正常。除普通外科肿瘤组术前油酸水平升高外，各癌症组之间的脂肪酸水平无显著差异；必需脂肪酸无缺乏情况。这些研究表明，对于正在接受化疗的癌症患者的营养补充，需要含有足够支链氨基酸并富含苏氨酸和赖氨酸的肠内配方。
