| Objectives Nutritional Risk Screening 2002(NRS 2002)scale and patient subjective global assessment(PG-SGA)scale were used to evaluate the nutritional status of cancer patients and the factors that influence it.A subcutaneous graft tumour model for colon cancer was also established,and investigate the effects of intestinal ecological immunonutrition(EIN)combined with oxaliplatin on the growth of colon cancer transplanted tumor,and observe the changes of the intestinal mucosal barrier and inflammatory factors in the serum of mice.Methods 1 From May 2019 to December 2020,69 cancer patients receiving chemotherapy in the Third Department of Oncology,Hebei General Hospital from May2019 to December 2020 were selected as the study subjects.The NRS 2002 and PG-SGA scales were completed and patients were assessed for nutritional risk and prevalence of malnutrition.Screening for causative factors associated with nutritional risk and malnutrition.2 Twenty-four 6-week-old male Balb/c mice were purchased and a CT26colon cancer cell line was used to construct a subcutaneous tumor model.The tumor-bearing mice were divided into 3 experimental groups(n=8).The first group was a blank control group with only 0.2 ml of saline instilled(control,CON group).The second group was a single agent chemotherapy group with an intraperitoneal injection of oxaliplatin and infusion of an equal amount of saline(L-OHP group).The third group was the intestinal ecological immunonutrition combined with the chemotherapy group,given equal doses of intestinal ecological immunonutrition preparation by gavage and oxaliplatin intraperitoneal injection(EIN+L-OHP group).Mice were weighed every four days and tumour diameters were recorded.The experiment was terminated after 21 d of intervention and the serum and colonic tissue of the mice were retained.The morphology of the colonic mucosa of each group was observed and recorded by HE staining.The expression positions and levels of intestinal mucosal barrier markers zona Occludens-1(ZO-1)and occludin were observed by immunohistochemistry technique.The concentrations of inflammatory cytokines IL-6 and IL-10 in serum were determined by enzyme-linked immunosorbent assay.Results 1 The majority of the 69 cancer patients were at nutritional risk(53,76.8%)and a minority were not(16,23.2%).Gender,BMI,and tumor site influenced the occurrence of nutritional risk in cancer patients(P<0.05).Male were more likely to have concurrent nutritional risks compared to female(86.0%vs 61.5%).Cancer patients with a BMI<18.5 were more likely to be at nutritional risk than those with a BMI≥18.5(86.0%vs 61.5%).Patients with digestive tract tumors were more likely to have a concurrent nutritional risk than patients with other tumors(87.2%vs 63.3%).However,the nutritional risk was not associated with age or the presence of diabetes or hypertension(P>0.05).2 The number of cancer patients with and without malnutrition was 54 and 15respectively(78.3%vs 21.7%).Gender and tumour site affect the occurrence of malnutrition in cancer patients(P<0.05).Male,with digestive tract tumors,were more likely to suffer from malnutrition than female,non-digestive tract tumors(86.0%vs65.4%;87.2%vs 66.7%).In contrast,the occurrence of malnutrition was not associated with age,BMI,the presence of concomitant diabetes or hypertension(P>0.05).3 After the experiment,the weight of tumor-bearing mice was weighed.As a result,the weight of the tumor-bearing mice in the CON group was found to be heavier than that of the L-OHP and EIN+L-OHP groups(P<0.05).There was no significant change in body weight in the EIN+L-OHP group of tumor-bearing mice compared to the L-OHP group(P>0.05).4 The tumor volumes in the CON,L-OHP,and EIN+L-OHP groups at the end of the experiment were:(4.46±2.55)cm~3,(2.69±1.11)cm~3 and(0.93±0.33)cm~3.The tumor volume was the smallest in the EIN+L-OHP group(P<0.05).There was no significant difference in tumor volume in the L-OHP group compared to the CON group(P>0.05).5HE staining showed the structural integrity of the colonic mucosa in the CON group,with scattered inflammatory cells and closely and regularly arranged epithelial cells.More inflammatory cells were present in the L-OHP group,as seen in the detachment of colonic mucosal epithelial cells and shortening and deformation of the villi.The colonic mucosa in the EIN+L-OHP group was structurally intact,with fewer inflammatory cells and a more regular arrangement of intestinal mucosal epithelial cells.6 The expression of ZO-1 and occludin was significantly higher in the EIN+L-OHP group than in the L-OHP group given chemotherapy(P<0.05).However,the expression of ZO-1 and occludin on the intestinal mucosa was not significantly different in the EIN+L-OHP group compared to the CON group(P>0.05).Compared with the CON group,the expression of ZO-1 and occludin proteins in the colon mucosa of mice treated with chemotherapy was significantly lower in the L-OHP group(P<0.05).7 The levels of IL-10 increased in the EIN+L-OHP group compared to the L-OHP group,but the difference was not statistically significant(P>0.05).IL-10 levels did not change significantly between the CON and EIN+L-OHP groups(P>0.05).In addition,the level of IL-10 after chemotherapy in the L-OHP group was significantly lower than that in the CON group(P=0.003).The expression level of IL-6 in serum of mice was not statistically significant among the three groups(P>0.05).Conclusions 1 Most cancer patients have different degrees of nutritional risk and malnutrition.Male,BMI<18.5,and patients with digestive tract tumors are more likely to be at nutritional risk.Male and digestive tract tumor patients are prone to malnutrition.2Intestinal ecological immunonutrition has the effect of chemotherapeutic sensitization,which may be achieved by reducing the damage of the intestinal mucosal barrier and inhibiting the inflammatory response.Figure 10;Table 7;Reference 153... |
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