De Cicco M, Panarello G, Fantin D, Veronesi A, Pinto A, Zagonel V, Monfardini S, Testa V
Anaesthesia, Resuscitation and Clinical Nutrition Unit, Istituto Nazionale di Ricovero e Cura a Carattere Scientifico, Aviano, Italy.
JPEN J Parenter Enteral Nutr. 1993 Nov-Dec;17(6):513-8. doi: 10.1177/0148607193017006513.
The role of total parenteral nutrition (TPN) in reducing toxicity related to cancer chemotherapy (CT) is presently a controversial issue. To evaluate the effectiveness of TPN in reducing CT-associated toxicity and correcting and preventing CT-related impairments of nutritional status, a prospective crossover controlled study was performed in 43 cancer patients (19 normally nourished and 24 malnourished) randomly divided into two groups (A and B). Group A patients received TPN concomitantly with the first course of chemotherapy, and the second course was administered 21 to 28 days later without TPN support; group B patients were treated in the opposite sequence. The rates of myelotoxicities and gastrointestinal toxicities after CT courses with or without TPN were essentially similar in normally nourished and malnourished patients. No changes in nutritional indexes were detected in normally nourished subjects after each course. Conversely, in undernourished subjects, prealbumin, retinol-binding protein, and nitrogen balance increased in CT+TPN courses (p < .02). In CT-only courses, undernourished subjects showed a decrease in prealbumin and nitrogen balance. Significant changes of nitrogen balance in CT vs CT+TPN courses were detected in malnourished subjects. TPN appears to be unable to reduce CT-associated toxicity. CT administration does not result in any impairment of the nutritional status in normally nourished cancer patients. From our study, it appears that TPN should be limited to severely malnourished neoplastic patients undergoing CT, because of its ability to prevent further impairment of nutritional status and to improve the nitrogen balance and the levels of fast-turnover visceral proteins.
全胃肠外营养（TPN）在降低与癌症化疗（CT）相关的毒性方面所起的作用目前是一个有争议的问题。为了评估TPN在降低CT相关毒性以及纠正和预防CT相关营养状况损害方面的有效性，对43例癌症患者（19例营养正常和24例营养不良）进行了一项前瞻性交叉对照研究，这些患者被随机分为两组（A组和B组）。A组患者在第一个化疗疗程时同时接受TPN，21至28天后进行第二个疗程且不给予TPN支持；B组患者则按相反顺序治疗。在营养正常和营养不良的患者中，接受或不接受TPN的CT疗程后的骨髓毒性和胃肠道毒性发生率基本相似。营养正常的受试者在每个疗程后未检测到营养指标的变化。相反，在营养不良的受试者中，CT + TPN疗程后前白蛋白、视黄醇结合蛋白和氮平衡增加（p < 0.02）。在仅接受CT的疗程中，营养不良的受试者前白蛋白和氮平衡下降。在营养不良的受试者中检测到CT与CT + TPN疗程之间氮平衡的显著变化。TPN似乎无法降低CT相关毒性。对于营养正常的癌症患者，进行CT治疗不会导致营养状况的任何损害。从我们的研究来看，TPN似乎应仅限于接受CT治疗的严重营养不良的肿瘤患者，因为它有能力防止营养状况进一步受损，并改善氮平衡和快速周转的内脏蛋白水平。
