本研究目的是評估結直腸癌患者術後接受化學治療之營養狀況、氧化狀態和細胞激素的變化。利用主觀性整體營養狀況評量表(The Patient-Generated Subjective Global Assessment；PG-SGA) 和半定量之飲食頻率問卷評估營養狀況和飲食攝取；採集癌症患者的血液檢體進行營養生化分析；單細胞膠體電泳（彗星試驗）將用來測量基線或 H2O2 誘發的淋巴球 DNA 氧化斷裂的狀況；總抗氧化能力分析 (TEAC)、脂質過氧化產物 (TBARS) 和蛋白質氧化產物(carbonyl groups) 作為鑑定癌症患者的氧化狀態。使用商品化之連結免疫吸收測定法 (ELISA) 來檢定細胞激素IL-6、INF-γ、TNF-?和 IL-1β。這些分析在進行化學治療之前與第二次化學治療二個星期之後執行。共38人全程參與本研究，平均年齡57.7 ± 12.7歲，平均身高159.1 ± 10.1 公分，化療前平均體重57.9 ± 10.9公斤，第二次化療後為58.7 ± 10.6公斤；患者為診斷分期第Ⅰ到第Ⅳ期的結直腸癌病人，第Ⅱ期患者占9.1﹪，第Ⅲ期占78.8﹪、第Ⅳ期占12.1﹪。患者接受二次化療後體重上升，但總抗氧化力下降。。使用『食用保健食品』、『每天吃足三份蔬菜』、『吃足二份水果』及『攝取奶類』的癌症患者在化療後顯著改善了氧化狀態；而增加『食用生機飲食』『食用營養補充品』，與血清鋅上升具顯著相關性；在化療過程中攝取『吃肉類食物』的癌症患者能明顯的提升維生素B12 及 腫瘤壞死因子-?並降低發炎指標C-反應蛋白。然而，偶爾『食用營養補充品』或經常『減少烹調用油』的患者，其血液總抗氧化力明顯下降。除此之外，化療後患者的血清鋅與抗氧化狀態具因果關係，因此，監測血清鋅的變化可評估患者的抗氧化狀態。綜合研究結果顯示膳食飲食因子確實會影響癌症患者化療後的整體營養狀況、氧化狀態和細胞激素之表現，可能也與化療過程中引發的併發症互有因果關係。本研究結論可以作為醫院建立結直腸癌症患者營養教育介入與諮詢的依據。 The purpose of this study was to evaluate the effect of nutritional condition, oxidative status and cytokine profiles on colorectal cancer patients receiving postoperative chemotherapy. Nutrition assessment and food intake were to assess with a patient-generated subjective global assessment (PG-SGA) and semiquantitative food-frequency questionnaire, respectively. Nutrition biochemical examination from blood in the cancer patients were detected in the analysis. Single-cell gel electrophoresis was used to measure baseline or H2O2-induced DNA strand breaks. Trolox equivalent antioxidant capacity assay (TEAC), thiobarbituric acid reactive substances (TBARS) and carbonyl groups assay were also evaluated with oxidative status of colorectal cancer patients. A commercially available enzyme-linked immunosorbent assay (ELISA) was used for quantitative detection of human cytokines IL-6, INF-γ, TNF-?and IL-1β.This survey was conducted before the chemotherapy and two weeks after the second chemotherapy. Thirty-eight patients participated in this study. The mean age was 57.7 ± 12.7 y and mean height was 159.1 ± 10.1 cm. The mean weight before the chemotherapy was 57.9 ± 10.9 and after the second chemotherapy was 58.7 ± 10.6 kg. All patients had a histologically confirmed diagnosis of stages I to IV colorectal cancer. 9.1％ of patients had stage II disease, 78.8％ had stage Ⅲand 12.1％ had stage IV. Patients received second chemotherapy could increase body weight, but decrease TEAC. Use of “health food”, “three serving for vegetable”, “two serving for fruit” and “milk” of cancer patients during chemotherapy had significantly improved antioxidative capacity. Increasing “living food diet”“health supplement”have significant relevance to the lift of serum zinc level. Use of “meat” of cancer patients during chemotherapy could significantly elevated vitamin B12 and TNF-? and decrease inflammatory C-reactive protein. However, seldom use of “nutrition supplements” or usually use of “useless for cooking oil” of cancer patients during chemotherapy had significantly decreased TEAC. In addition, serum zinc level of cancer patients during chemotherapy had significantly relationship with antioxidative capacity. Therefore, monitoring patients’ serum level change can help evaluate their antioxidative capacity. In conclusion, the frequency and type of dietary intake could affect nutritional status, antioxidative capacity and some cytokine expression in cancer patients after chemotherapy, and may be related to complication for cancer patients with chemotherapy. The findings of this research will define the positive synergistic factor for alleviating cancer chemotherapy-related symptoms, and can help the hospital to establish nutrition education and consultation models for colorectal cancer patients.
