晚期胰腺痛减黄术后化疗加肠外营养支持的随机对照研究
作者：刘建东 才又红
单位：河北省邯郸市第一医院
关键词：
中国临床营养杂志000121摘 要：目的探讨营养支持在晚期胰腺癌姑息减黄术后化疗病人中的作用，及对病人的营养、免疫、生活质量及肿瘤疗效的影响。 方法1996年1月至1999年1月，对有病理学诊断和术中临床分期的40例姑息减黄术后的进展期胰腺癌病人进行随机分组，。术后给予联合化疗(FCMP/A)，或加用干扰素γ。联合化疗方案：5氟尿嘧啶300～400mg/m2，甲酰四氢叶酸钙200mg/次，24小时持续静脉滴注，分别在3、5、10、12天给予，丝裂霉素4～6mg/m2、顺铂或表阿霉素20～30mg/m2第一天静注。以上药物可根据病人化疗中反应情况适当调整。每21天为1周期，间歇1周重复，完成至少2个周期。干扰素γ300万IU/天，每周3次，共6周。评定疗效标准按WHO实体瘤疗效标准分为CR(完全缓解)、PR(部分缓解)、NC(无变化)、PD(进展)。40例病人随机分为治疗组和对照组，治疗组为联合化疗加营养支持，共20例，其中男12例，女8例，中位年龄57.8(43～69)岁。对照组为联合化疗加常规治疗，共20例，其中男13例，女7例，中位年龄58.2(45～69)岁。肠外营养方案：每日静脉供给非蛋白(NPC)热量20Kcal·k8-1·d-1，热氮比125Kcal·kg-1·d-1，糖脂比6：4，治疗组接受肠外营养平均11.5天(8～15天)。检验两组病人的营养、免疫状态，生活质量及化疗效果。 结果治疗组的前白蛋白，转铁蛋白，视黄醇结合蛋白，外周淋巴细胞总数，自然杀伤细胞活性，白介素-2受体阳性细胞，生活质量评分，化疗药物毒性作用消失时间和生存时间均不同程度的优于对照组(P<0.05或P<0.01)。非随机性对照使用干扰素未发现差异(P>0.05)。 结论对进展期胰腺癌姑息减黄术后的病人进行联合化疗，同时给予合理的营养支持能够提高营养、免疫水平，改善生活质量，延长生存时间，提高化疗效果。但是病人未能达到长期的无瘤生存。
, http://www.100md.com
A randomised study of parenteral nutritional suport in the post-palliative operations of advanced pancreatic carcinoma patients receiving chemotherapy
LIU Jiandong ,CAI Youhong
(The First Hospital of Handan, Hebei 056002)
Abstract：Objective The incidence of pancreatic cancer is increasing worldwide, and also in china. The characteristics of the cancer are: short course, rapid progress and high mortality, with median survival time of about 6 months. Unfortunately, the early symptoms of patients are not peculiarity. There are not simple, direct and effective methods of early diagnosis. When the patients have jaundice and abdominal pain, probably they are the advanced disease (stage Ⅲ-Ⅳ) ,with unresectable tumours,and have to perform biliary bypass operation for alleviative treatment. Furthermore, the most of all patients exhibit advanced disease, which is often associated with a reduced performance status, malnourished condition, immune function deficiency, all of which severely limit patients tolerance for toxic chemotherapy regimens. These may result in physiological problems that can alter the metabolism and distribution of cytotoxic drugs and therefor lead to an increase in treatment-related toxicity. Purpose To explore the effect of TPN in the post-palliative operations, Roux-en-Ycholedceho-jejunostomy, of advaneed pancreatic carcinoma patients receiving chemotherapy. Methods From Jan. 1996 to Jan. 1999, 40 cases had receiving combination chemotherapy after palliative operations for relief of jaundice by biliary hypass, and surgical biopsy for histologically cemented. The patients were randomly divided inter 2 groups: (1) treatment group (chemotherapy + TPN), 12 men and 8 women had a median age of 57.8 years old. (2) Control group (chemotherapy + routine treatment), 13 men and 7 women had a median age of 58.2 years old. All the patients received combined chemotherapy, the regimen was 5-Fu+ CF + MMC + DDP/EPI (5-fluorouracil + Calcium folniate + Mitomycin C + Cisplatin or Epirubicin ) or IFN-γ (interferon-γ). Dosages of drugs were modified for bone marrow toxicity, stomatits and declining performance status. After 28 days, the regimen performed once again. The regimen of TPN was: total caloric value (NPC) 20 Kcal/kg·d, nitrogen 0.2kg/kg·d, N/Q = 1g: 125Kcal, Glucose/Fat=6:4. The nutritional & immunological parameters, quality of life, effects of treatment wrer monitored. Results Treatemnt group is superior to control group. After TPN, serum pre. albumin, transferrin concentration, retinol-binding protein, total lymphocyte count, natural killer cells activity, IL-2R+ cells (CD25) percentage of peripheral blood, grades of quality of life and survival time increased significantly (P<0.05, P<0.01 respectively). However, no significant difference was observed in IFN-γ application group (P>0.05). Conelusions The nutritional support can improve nutritional and immune situation and quality of life, and prolong the survival time of the patients, but no relapse-free survival., 百拇医药
单位：河北省邯郸市第一医院
关键词：
中国临床营养杂志000121摘 要：目的探讨营养支持在晚期胰腺癌姑息减黄术后化疗病人中的作用，及对病人的营养、免疫、生活质量及肿瘤疗效的影响。 方法1996年1月至1999年1月，对有病理学诊断和术中临床分期的40例姑息减黄术后的进展期胰腺癌病人进行随机分组，。术后给予联合化疗(FCMP/A)，或加用干扰素γ。联合化疗方案：5氟尿嘧啶300～400mg/m2，甲酰四氢叶酸钙200mg/次，24小时持续静脉滴注，分别在3、5、10、12天给予，丝裂霉素4～6mg/m2、顺铂或表阿霉素20～30mg/m2第一天静注。以上药物可根据病人化疗中反应情况适当调整。每21天为1周期，间歇1周重复，完成至少2个周期。干扰素γ300万IU/天，每周3次，共6周。评定疗效标准按WHO实体瘤疗效标准分为CR(完全缓解)、PR(部分缓解)、NC(无变化)、PD(进展)。40例病人随机分为治疗组和对照组，治疗组为联合化疗加营养支持，共20例，其中男12例，女8例，中位年龄57.8(43～69)岁。对照组为联合化疗加常规治疗，共20例，其中男13例，女7例，中位年龄58.2(45～69)岁。肠外营养方案：每日静脉供给非蛋白(NPC)热量20Kcal·k8-1·d-1，热氮比125Kcal·kg-1·d-1，糖脂比6：4，治疗组接受肠外营养平均11.5天(8～15天)。检验两组病人的营养、免疫状态，生活质量及化疗效果。 结果治疗组的前白蛋白，转铁蛋白，视黄醇结合蛋白，外周淋巴细胞总数，自然杀伤细胞活性，白介素-2受体阳性细胞，生活质量评分，化疗药物毒性作用消失时间和生存时间均不同程度的优于对照组(P<0.05或P<0.01)。非随机性对照使用干扰素未发现差异(P>0.05)。 结论对进展期胰腺癌姑息减黄术后的病人进行联合化疗，同时给予合理的营养支持能够提高营养、免疫水平，改善生活质量，延长生存时间，提高化疗效果。但是病人未能达到长期的无瘤生存。
, http://www.100md.com
A randomised study of parenteral nutritional suport in the post-palliative operations of advanced pancreatic carcinoma patients receiving chemotherapy
LIU Jiandong ,CAI Youhong
(The First Hospital of Handan, Hebei 056002)
Abstract：Objective The incidence of pancreatic cancer is increasing worldwide, and also in china. The characteristics of the cancer are: short course, rapid progress and high mortality, with median survival time of about 6 months. Unfortunately, the early symptoms of patients are not peculiarity. There are not simple, direct and effective methods of early diagnosis. When the patients have jaundice and abdominal pain, probably they are the advanced disease (stage Ⅲ-Ⅳ) ,with unresectable tumours,and have to perform biliary bypass operation for alleviative treatment. Furthermore, the most of all patients exhibit advanced disease, which is often associated with a reduced performance status, malnourished condition, immune function deficiency, all of which severely limit patients tolerance for toxic chemotherapy regimens. These may result in physiological problems that can alter the metabolism and distribution of cytotoxic drugs and therefor lead to an increase in treatment-related toxicity. Purpose To explore the effect of TPN in the post-palliative operations, Roux-en-Ycholedceho-jejunostomy, of advaneed pancreatic carcinoma patients receiving chemotherapy. Methods From Jan. 1996 to Jan. 1999, 40 cases had receiving combination chemotherapy after palliative operations for relief of jaundice by biliary hypass, and surgical biopsy for histologically cemented. The patients were randomly divided inter 2 groups: (1) treatment group (chemotherapy + TPN), 12 men and 8 women had a median age of 57.8 years old. (2) Control group (chemotherapy + routine treatment), 13 men and 7 women had a median age of 58.2 years old. All the patients received combined chemotherapy, the regimen was 5-Fu+ CF + MMC + DDP/EPI (5-fluorouracil + Calcium folniate + Mitomycin C + Cisplatin or Epirubicin ) or IFN-γ (interferon-γ). Dosages of drugs were modified for bone marrow toxicity, stomatits and declining performance status. After 28 days, the regimen performed once again. The regimen of TPN was: total caloric value (NPC) 20 Kcal/kg·d, nitrogen 0.2kg/kg·d, N/Q = 1g: 125Kcal, Glucose/Fat=6:4. The nutritional & immunological parameters, quality of life, effects of treatment wrer monitored. Results Treatemnt group is superior to control group. After TPN, serum pre. albumin, transferrin concentration, retinol-binding protein, total lymphocyte count, natural killer cells activity, IL-2R+ cells (CD25) percentage of peripheral blood, grades of quality of life and survival time increased significantly (P<0.05, P<0.01 respectively). However, no significant difference was observed in IFN-γ application group (P>0.05). Conelusions The nutritional support can improve nutritional and immune situation and quality of life, and prolong the survival time of the patients, but no relapse-free survival., 百拇医药