肠外营养对NSCLC术后患者化疗的临床效果影响

Clinical effect of parenteral nutrition on patients with non-small cell lung cancer undergoing postoperative chemotherapy

摘要:

目的 观察肠外营养治疗对非小细胞肺癌（NSCLC）术后行吉西他滨联合奈达铂化疗患者的临床效果影响。 方法 用前瞻性研究方法，选取2017年7月至2019年10 月的258例经微创手术切除且术后行规范化疗的非小细胞肺癌（NSCLC）患者为研究对象，分为治疗组63例，对照组195例。对照组仅行常规肠内营养支持，治疗组在对照组基础上加用肠外营养支持，比较两组化疗后营养状况、免疫功能、肺功能及不良反应发生率情况；采用Logistic回归分析肠外营养治疗及相关因素与肺癌术后并发症的关系。 结果 195例对照组患者和63例治疗组患者经倾向评分匹配后每组53例，治疗组化疗后的BMI和营养指标（HB、TP、ALB 、PA）数值高于对照组，差异有统计学意义（P < 0.05）；治疗组化疗后的免疫指标（CD4+ 、CD4+ /CD8+、IgG、IgA、IgM）及肺功能指标（FVC、FEV1）数值均高于对照组，差异有统计学意义（P < 0.05）；Logistic 回归分析结果显示：CD4+、IgG及FVC是肺癌术后并发症的保护因素。 结论 非小细胞肺癌术后患者化疗时应给予肠外营养支持治疗，可改善营养状况、增强免疫力、改善肺功能，进而减少术后并发症的发生。

Abstract:

Objective To observe the effect of parenteral nutrition on postoperative non-small cell lung cancer （NSCLC） patients treated by gemcitabine combined with nedaplatin chemotherapy. Methods Based on the prospective cohort study，258 patients with NSCLC who underwent minimally invasive surgical resection and received standard chemotherapy after surgery from July 2017 to October 2019 were selected as research objects，and they were divided into the treatment group （n = 63） and the control group （n = 195）. The control group only received enteral nutrition，while the treatment group was added parenteral nutrition. Nutritional status，immune function，lung function and incidence of adverse reactions were compared between the two groups after chemotherapy. Logistic regression was used to analyze the relationship between parenteral nutrition therapy and its related factors and postoperative complications of lung cancer. Results 53 patients were selected from the control group （195 cases），and 53 patients were selected from the treatment group （63 cases） by the method of propensity score matching. The values of anthropometric parameters （BMI） and nutritional parameters （HB，TP，ALB，PA） of the treatment group after chemotherapy were higher than those of the control group，and the differences were statistically significant （P < 0.05）. The values of immune function parameters （CD4+，CD4+/CD8+，IgG，IgA，IgM） and the lung function parameters （FVC，FEV1） of the treatment group were higher than those of the control group，and the differences were statistically significant （P < 0.05）. Logistic regression analysis showed that CD4+，IgG and FVC were the protective factors of postoperative complications of lung cancer. Conclusion Parenteral nutrition support treatment should be given to NSCLC patients treated with postoperative chemotherapy，for it could improve the nutritional status，enhance the immunity function，improve the lung function and reduce the postoperative complications.