Nixon D W, Lawson D H, Kutner M, Ansley J, Schwarz M, Heymsfield S, Chawla R, Cartwright T H, Rudman D
Cancer Res. 1981 Jun;41(6):2038-45.
Because protein-calorie undernutrition is common in patients with neoplastic disease, nutritional support is often recommended. It is uncertain, however, that methods of supplemental alimentation successful in noncancerous subjects are suitable in cancer patients. We measured elemental balances, serum proteins, anthropometrics (triceps skinfold and mid-arm muscle area), and creatinine/height ratio in 15 undernourished patients with advanced cancer and in 10 noncancer undernourished controls during central venous or enteral hyperalimentation and found the following. (a) During central venous hyperalimentation, cancer patients showed significantly less improvement than the noncancerous controls in body weight (median increment, 5 kg in cancer patients and 8.5 kg in noncancerous), albumin (0.1 g/dl in cancer patients and 0.5 g/dl in noncancerous patients), creatinine/height ratio (4% of standard in cancer and 10% of standard in noncancer), and mid-arm muscle area (4% of standard in cancer and 11% of standard in noncancer). During enteral hyperalimentation, gains in body weight and albumin by cancer patients were significantly inferior to those in noncancerous subjects. Triceps skinfold increments, in contrast, were similar during both central venous and enteral hyperalimentation for cancer and noncancerous patients. (b) While nitrogen retention was similar in cancer and noncancer patients, the cancer group retained significantly less magnesium and phosphorus (delta Mg in cancer patients, 3.2 mEq/day central, -2.7 mEq/day enteral; delta Mg in noncancer patients, 11.9 mEq/day central, 10.1 mEq/day enteral; delta P in cancer patients, 0.13 g/day central, 0.07 g/day enteral; delta P in noncancer patients, 0.27 g/day central, 0.33 g/day enteral). The poorer balances of cancer patients were caused by increased urinary, not fecal, loss. These findings indicate a partial block in repletion of lean body mass or abnormal composition of newly deposited lean body mass when undernourished patients with advanced cancer receive hyperalimentation.
由于蛋白质 - 热量营养不良在肿瘤疾病患者中很常见，因此通常建议给予营养支持。然而，在非癌症患者中成功的补充营养方法是否适用于癌症患者尚不确定。我们在15例晚期癌症营养不良患者和10例非癌症营养不良对照者进行中心静脉或肠内高营养期间，测量了元素平衡、血清蛋白、人体测量指标（肱三头肌皮褶厚度和上臂中部肌肉面积）以及肌酐/身高比值，结果如下。(a) 在中心静脉高营养期间，癌症患者在体重（癌症患者中位数增加5 kg，非癌症患者增加8.5 kg）、白蛋白（癌症患者增加0.1 g/dl，非癌症患者增加0.5 g/dl）、肌酐/身高比值（癌症患者为标准值的4%，非癌症患者为10%）和上臂中部肌肉面积（癌症患者为标准值的4%，非癌症患者为11%）方面的改善明显低于非癌症对照者。在肠内高营养期间，癌症患者体重和白蛋白的增加明显低于非癌症患者。相比之下，癌症患者和非癌症患者在中心静脉和肠内高营养期间肱三头肌皮褶厚度的增加相似。(b) 虽然癌症患者和非癌症患者的氮潴留相似，但癌症组保留的镁和磷明显较少（癌症患者中心静脉时δMg为3.2 mEq/天，肠内时为 -2.7 mEq/天；非癌症患者中心静脉时δMg为11.9 mEq/天，肠内时为10.1 mEq/天；癌症患者中心静脉时δP为0.13 g/天，肠内时为0.07 g/天；非癌症患者中心静脉时δP为0.27 g/天，肠内时为0.33 g/天）。癌症患者较差的平衡是由尿中而非粪便中丢失增加所致。这些发现表明，晚期癌症营养不良患者接受高营养时，瘦体组织的补充存在部分障碍或新沉积的瘦体组织组成异常。
