Investigation On Nutrition Status Of Advanced Nonsmall Cell Lung Cancer Patients And The Effect Of Glutamine Supplementation

Objectives To investigate the nutritional status and analyze the influencing factors of malnutrition of patients with advanced non-small cell lung cancer(NSCLC).To explore the effect of oral glutamine on malnutrition,immune function,chemotherapy related adverse reactions and chemotherapy delay in NSCLC patients undergoing chemotherapy.Methods 1 Advanced NSCLC patients who were diagnosed by pathology or cytology in Tangshan people’s Hospital from July 2015 to August 2016 were selected as the subjects.General situation questionnaire and patient-generated subjective global assessment(PGSGA)were used for questionnaires.N utritional status of patients was assessed by laboratory tests and physical examination.The fasting venous blood sample drawn for routine blood test,nutritional indicators and immune indices and the height,weight and body mass index were abtained in next morning after hospitalization.2 According to "minimum randomization method",advanced NSCLC patients with malnutrition were divided into the experimental group and the control group,52 cases in each group,both treated with Paclitaxel and C isplatin chemotherapy.The control group was given conventional nutritional support treatment,while the experimental group was treated with glutamine 10 g each time,three times a day on the basis of nutritional support,both intervened for 28 days.We respectively compared the nutritional status,nutritional indicators,immune indices,the incidence of adverse reactions of chemotherapy and delayed treatment between the two groups of patients in order to evaluate the effect of glutamine intervention.All the data were performed through Excel,established data file and analyzed by SPSS 17.0 statistical software.Results 1 A total of 272 advanced NSCLC patients were investigated.99 patients with good nutritional status(PG-SGA A)accounted for 36.4% and 173 patients with varying degrees of malnutrition(PG-SGA B+PG-SGA C)accounted for 63.6%,O f which 55 with severe malnutrition(PG-SGA C)accounting for 20.2%.2 Univariate analysis showed that age and clinical stage had an impact on the nutritional status of NSCLC patients,the difference was statistically significant(P<0.05).The proportion of malnutrition of patients over 65 years old was 74.4%,higher than whose age under 65 years(58.9%);the proportion of malnutrition of patients with clinical stage Ⅳ was 78.3%,higher than those of patients with stage Ⅲ(48.5%).The levels of RBC、TP、ALB、PALB、HB、LY、CD3+、CD4+、CD8+、Ig G、KPS and BMI of NSCLC patients with good nutritional status were higher than those of malnourished patients.3 Multivariate logistic regression analysis showed that clinical stage,KPS score and BMI were the factors affecting the nutritional status of NSCLC patients.The later clinical stage,the lower KPS score and BMI,the higher was the risk of malnutrition in NSCLC patients.4 Glutamine intervention study included 104 NSCLC patients with chemotherapy who met the inclusion criteria,52 patients in each group.There was no significant difference in age、gender、place of residence、educational level、 monthly income 、clinical stage and pathological type between the two groups(P>0.05),indicating that the basic characteristics of the two groups were comparable.5 Before intervention,there was no significant difference of nutritional indicators such as HB、TP、ALB and PALB between the two groups(P>0.05).After intervention,HB、TP、ALB and PALB of experimental group were higher than those of control group and the difference was statistically significant(P<0.05).It suggests that glutamine intervention has positive effect on improving the nutritional indicators ofpatients.6 Before intervention,there was no significant statistic difference in PG-SGA score between the two groups(P>0.05).After intervention,PG-SGA score of experimental group was significantly lower than that of control group(P<0.01).The results showed that glutamine intervention can markedly improve the nutritional status of patients.7 Before intervention,there was no significant statistic differe nce in immune indices between the two groups(P>0.05).After intervention,C D8+、Ig G and Ig A of experimental group were higher than those of control group.C D3+ and CD4+ of experimental group after intervention increased than those before intervention.The difference of CD3+、CD4+ and Ig G between the two group s were statistically significant(P<0.05).8 The incidence of chemotherapy-related diarrhea and peripheral neurotoxicity in experimental group respectively were 17.3% and 38.5%,which were significantly lower than those in control group(40.4%、59.6%).There was no significant difference in the incidence of nausea,vomiting and thrombocytopenia between experimental group and control group(P>0.05).9 The proportion of delayed chemotherapy was 1.9% in experimental group,which was significantly lower than that in control group(15.4%),the difference was statistically significant(P<0.05).Conclusions 1 The incidence of malnutrition in patients with advanced NSCLC was 63.6%.Clinical stage,KPS score and BMI were the factors affecting the nutritional status of patients with advanced NSCLC.With late clinical stage,low KPS score and BMI,the risk of malnutrition in NSCLC patients was increased.2 Glutamine can improve the nutritional status of patients with advanced NSCLC undergoing c hemotherapy,and improve their immune function,especially cellular immunity.3 Glutamine can alleviate chemotherapy-related diarrhea and peripheral neurotoxicity,reduce the proportion of delayed chemotherapy and improve treatment to lerance.