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目的阐明不同营养支持方案对化疗期间非小细胞肺癌(non-small cell lung cancer,NSCLC)患者T淋巴细胞功能的影响,为NSCLC患者在化疗中优选营养支持方案提供理论依据。方法将93例NSCLC患者随机分为3组：对照组30例、低剂量部分肠外营养(partial parenteral nutrition,PPN)组32例和高剂量PPN组31例。各组均应用统一的化疗方案。化疗期间在饮食平行的基础上,对照组仅给予常规处理,PPN组予以静脉营养支持：低剂量组给予250 ml/d 9-AA复合氨基酸,高剂量组给予500 ml/d 9-AA复合氨基酸。分别于化疗前后检测CD3~+、CD3~++CD4~+、CD3~++CD8~+和自然杀伤细胞(NK)等。结果化疗前后3组的NK细胞、CD3~+、CD3~++CD4~+的降低(P＜0．05),其中对照组和低剂量组化疗后的NK细胞变化有统计学意义(P＜0．01)；高、低剂量组化疗前后CD3~+、CD3~++CD4~+、CD3~++CD4~+/CD3~++CD8~+的变化与对照组相比较,差异有统计学意义(P＜0．05)；高、低剂量组的CD3~++CD8~+、CD3~++CD4~+/CD3`++CD8~+的变化差异无统计学意义(P＞0．05)。结论化疗可加重NSCLC患者的营养不良和免疫抑制,而化疗期间给予一定量的9-AA复合氨基酸肠外营养支持可能对NSCLC患者免疫功能进一步恶化有一定的预防作用,对改善营养状况、提高T-淋巴细胞功能也有一定的作用。
Objective To elucidate the effect of different nutritional support protocols on the function of T lymphocytes in patients with non-small cell lung cancer (NSCLC) during chemotherapy, and to provide a theoretical basis for optimizing nutritional support for chemotherapy in patients with NSCLC. Methods Ninety-three NSCLC patients were randomly divided into three groups: control group (n = 30), partial dose of partial parenteral nutrition (n = 32) and high dose group (n = 31). All groups applied a uniform chemotherapy regimen. On the basis of the parallel diet during the chemotherapy, the control group was treated only routinely, while the PPN group received intravenous nutrition support. The low dose group was given 250 ml / d 9-AA complex amino acid and the high dose group was given 500 ml / d 9-AA complex amino acid . CD3 ~ +, CD3 ~ + + CD4 ~ +, CD3 ~ + CD8 ~ + and NK cells were detected before and after chemotherapy. Results The levels of NK cells, CD3 +, CD3 + + CD4 + in the three groups before and after chemotherapy decreased (P <0.05), and the changes of NK cells in the control and low dose groups after chemotherapy were statistically significant (P < 0.01). The changes of CD3 ~ +, CD3 ~ ++ CD4 ~ +, CD3 ~ + + CD4 ~ + / CD3 ~ + + CD8 ~ + before and after chemotherapy in high and low dose groups were statistically different from those in control group (P <0.05). There was no significant difference of CD3 ~ + CD8 ~ +, CD3 ~ + + CD4 ~ + / CD3 ~ + CD8 ~ + in high and low dose groups .05). Conclusion Chemotherapy can aggravate malnutrition and immunosuppression in patients with NSCLC. However, given a certain amount of 9-AA compound amino acid parenteral nutrition during chemotherapy, it may prevent further deterioration of immune function in patients with NSCLC, improve the nutritional status, increase the T Lymphocyte function also has a role.