| Multiple myeloma(MM)is a hematological malignant tumor with clonal plasma cell abnormal proliferation.Abnormal plasma cell proliferation leads to bone disease(osteolytic damage,bone pain,pathological fracture),hypercalcemia and anemia etc.The secretion of M protein inhibits the synthesis of immunoglobulin,causing patients to be prone to systemic and local infections;Benzhou’s protein appears in the urine;severe renal function is impaired.The incidence of MM in China is about 1/100,000,which is lower than that of Western developed countries(about 4/100,000),but it has gradually increased in recent years.There is still no cure for MM.With the continuous advent of monoclonal antibodies and other immune drugs and the improvement of detection methods,the level of diagnosis and treatment of MM has been continuously improved.The patient’s quality of life is a key predictor of disease outcome,and the main goal of treatment is to improve symptoms and improve quality of life.Recently,more and more studies have found that the nutritional status of MM patients affects their prognosis and quality of life seriously.Many MM patients are in a state of malnutrition,and the body’s lean tissues are constantly consumed,resulting in impaired tissue function,which is one of the important factors leading to death ultimately.Malnutrition can also reduce the body’s immunity,which will affect the effect of treatment and increase the incidence of complications.The symptoms of patients are not easy to control,the quality of life is reduced,and the clinical outcome is poor,which requires attention.Nutritional support for MM patients has become an important part of the multidisciplinary comprehensive treatment of the disease.Reasonable and effective nutritional support has a positive effect on improving the outcome and life quality of the patients’.Scientific and reasonable nutritional support can effectively improve malnutrition,improve immunity,enhance therapeutic effects,improve the final outcome,and improve the life quality of patients.At present,there are few reports on malnutrition of multiple myeloma,and there is insufficient clinical understanding of the malnutrition status of MM patients,and there is a dispensable attitude towards nutritional support.Besides,patients lack nutritional knowledge,have many misunderstandings and improper access to knowledge.According to research,more than 90%of cancer patients believe that protein-rich foods should not be eaten when they attacked by the illness.Most patients who agree to receive nutritional supplements also take oral nutritional supplements.However,most patients with MM will have large oral mucosa ulcers after chemotherapy,which will cause oral intake disorders and aggravate the patients’malnutrition.Therefore,most patients with oral intake disorders or pain can hardly reach the target intake the amount.The definition of the supplementary parenteral nutrition(SPN)is that when enteral nutrition cannot meet the nutritional needs of patients,and more nutritional substrates are needed,it needs to be supplemented by parenteral route,and a mixed nutritional support treatment method is adopted.Studies found that compared with enteral nutrition(EN)support,parenteral nutrition(PN)did not increase patient complications and mortality.Under the condition that EN cannot meet the target requirements of MM patients,SPN can effectively ensure the nutritional intake of MM patients.Compared with total enteral nutrition,SPN is a more effective means of nutritional support for MM patients.SPN meets the nutritional needs of patients,provides sufficient energy and protein,and then regulates the body’s nitrogen balance,promotes protein synthesis,improves the body’s nutritional status,promotes the overall recovery of the patient,reduces the incidence of complications,improves the body function,and improves the treatment effect which make the patients get the most benefit.Research purposesThe purpose of this study is to implement SPN for malnourished MM patients and compare the changes of SPN and EN on the nutritional status and related indicators of patients,to determine the best clinically suitable nutritional intervention methods for MM patients,and to explore nutritional treatment methods for MM patients.Standard supplementary parenteral nutrition therapy for MM patients and future clinical supplementary parenteral nutrition therapy provide experimental evidence.Research objects and research methods1.Objective:Estimated after 5 days of oral diet or enteral nutrition in the Department of Hematology Oncology,Zhabei Central Hospital,Jing’an District,who was admitted to the Department of Hematology and Oncology between March 2016 and September 2018.Patients with multiple myeloma who survive for more than 3 months.Nutrition risk screening and assessment were performed before treatment.2.Groups:According to the random single-blind method,the 200 MM patients included in this study were divided into conventional enteral nutrition treatment group(EN group)and supplementary parenteral nutrition treatment group(SPN group),of which 100cases were in EN group.100 cases in SPN group.3.Methods:The research process includes nutritional risk screening,nutritional assessment,nutritional diagnosis,nutritional therapy,nutritional monitoring,nutritional re-evaluation,and re-treatment.The EN group was given intact protein enteral nutrition powder combined with ordinary liquid on the day of enrollment,and energy and protein were supplied at 30kcal/kg/d and 1.2g/kg/d respectively.During this period,the patients should be closely observed for adverse reactions,such as Diarrhea,abdominal pain and abdominal distension,etc.,and the duration of treatment is 15 days.SPN group patients were given SPN plus intact protein enteral nutrition powder on the day of enrollment.The content of energy and nitrogen and other proteins is equal to that of the control group,mainly for the all-in-one supplement of compound amino acids with glutamine injection and medium and long chain fat emulsions.Parenteral nutrition,the dosage is 1000m L,and the treatment time is also 15 days.4.Indicators:(1)Related indicators of nutritional assessment before and after nutritional support for the two groups of patients,including NRS-2002 score,PG-SGA score,anthropometric indicators(triceps skinfold thickness,BMI,body fat ratio,skeletal muscle content,Phase angle PA,etc.);(2)Biochemical indicators before and after nutritional support(plasma albumin,prealbumin,hemoglobin,C-reactive protein,creatinine,TNF-α,IL-6,cystatin C,etc.);(3)Morbidity of infection in the two groups and other complications;(4)Days of hospitalization.5.Statistical analysis:Statistical analysis was performed on the data with SPSS22.0software.The comparison between groups was performed by t test and?~2 test.The grade comparison was performed by Fisher test.P<0.05 indicated that the difference was statistically significant.Results1.All surveyed MM patients had malnutrition before nutritional intervention,and it is estimated that the oral diet for 5 days will not reach 60%of the target requirement.2.Before nutritional therapy,the two groups of patients had BMI(t=1.55,P=0.12)in age(t=1.41,P=0.16),gender(?2=2.44,P=0.12),time of admission(t=1.57,P=0.12),skinfold thickness(t=0.62,P=0.54),NRS-2002 screening score(t=0.96,P=0.34),PG-SGA assessment of moderate malnutrition rate(?2=0.20,P=0.65)),body composition analysis[total skeletal muscle(t=0.76,P=0.45),body fat percentage(t=1.12,P=0.27)and phase angle PA(t=1.09,P=0.28)]have no significant differences.3.After nutritional treatment,compared with EN group,SPN group skinfold thickness(t=0.36,P=0.72),skeletal muscle content(t=1.57,P=0.12)and body fat percentage(t=0.25,P=0.80),etc.There is no significant change in aspects;while BMI(t=4.82,P<0.001)and phase angle increase significantly(t=17.89,P<0.001).4.After nutritional support,the NRS-2002 score of the EN group was lower than before the support(t=0.60,P=0.44),without statistically significant;the NRS-2002 score of the SPN group after nutritional support was significantly lower than that before the support(t=10.36,P<0.001).The PG-SGA nutritional assessment of the EN group before and after treatment showed no significant change in the rate of moderate malnutrition(?2=0.39,P=0.53);while the rate of moderate malnutrition in the PG-SGA assessment of the SPN group decreased from 90%to 72%(?2=10.53,P=0.001),and significantly lower than the EN group(2=5.01,P=0.03).5.After nutritional therapy,plasma prealbumin(t=10.21,P<0.0001)and upper arm circumference(t=16.38,P<0.0001)of SPN group were significantly higher than those of EN group;while albumin(t=1.49,P=0.14),hemoglobin(t=1.08,P=0.28)there was no significant difference between the two groups after treatment.6.After nutritional support,compared with EN group,SPN group ALT(t=1.09,P=0.28),fasting blood glucose(t=0.42,P=0.67)did not change significantly,but blood creatinine decreased significantly(t=208.8,P<0.0001).7.After nutritional support,the incidence of infection in the SPN group was 12%,which was significantly lower than that in the EN group(2=4.19,P<0.05).The total incidence of gastrointestinal adverse reactions in the SPN group was significantly lower than that in the EN control group(2=6.82,P<0.05).8.After 15 days of nutritional support in the SPN group,IL-6(t=7.86,P<0.0001),TNF-α(t=18.97,P<0.0001)and CRP(t=28.96,P<0.0001)levels were higher than before treatment After nutritional support,IL-6(t=8.12,P<0.0001),TNF-α(t=16.08,P<0.0001),CRP(t=41.19,P<0.0001)of SPN group were significantly lower than those of EN group.9.The average length of stay in the SPN group was(21.87±1.23)days and that in the EN group was(22.31±1.57)days.After nutritional therapy,the length of stay in the SPN group was significantly lower than that in the EN group(t=2.81,P=0.005).ConclusionsThis study used The EN and SPN were used for MM malnourished patients in this study.The effects of the two nutritional treatments on the nutritional status and clinical indicators of MM patients were compared.The main conclusions are:1.Supplementary parenteral nutrition therapy can better improve the malnutrition of patients,which is suggested that in addition to energy and protein supply,nutritional support should be paid attention to and individualized nutrition therapy should be emphasized.2.Supplementary parenteral nutrition can better reduce the inflammatory response level of MM patients,improve the immune status,and reduce the incidence of infection and adverse reactions.3.Supplementary parenteral nutrition can shorten the length of time in hospital,which is beneficial to the improvement of health economic indicators. |
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