乳癌患者手術後接受化學治療之營養狀況、氧化狀態及 發炎反應

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標題:	乳癌患者手術後接受化學治療之營養狀況、氧化狀態及發炎反應 Nutritional condition, oxidative status and inflammation of breast cancer patients receiving postoperative chemotherapy
作者:	葉志鴻
貢獻者:	陳姿秀陳師瑩嘉南藥理科技大學：營養與保健科技研究所
關鍵字:	細胞激素變化氧化狀態營養狀況化學治療乳癌 cytokine profiles oxidative status nutritional condition chemotherapy breast cancer
日期:	2010
上傳時間:	2010-12-30 09:48:27 (UTC+8)
摘要:	本研究目的是評估乳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 INF-γ、IL-1β、IL-6、和TNF-α。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 28人全程參與本研究，平均年齡 53.7 ± 12.0 歲，平均身高 157.5 ± 5.6 公分，化療前平均體重 61.6 ± 12.8 公斤，第二次化療後為 61.9 ± 12.6 公斤；患者為診斷分期第 I 到第 III 期的乳癌病人，第 I 期患者占25.0％，第 II 期占 35.7％、第 III 期占 39.2％。患者接受化療後營養狀況顯著下降，且降低血液中貧血指標 RBC、Hb、Hct、MCHC的濃度，免疫發炎指標的 WBC 及 Eosinophils 細胞數，Transferrin及血清鋅的含量。營養狀況較佳的患者，接受化療後有較高的 DNA氧化傷害。化療前『豆製品』攝食頻率愈高，或化療後增加『吃足三份蔬菜』頻率，與貧血指標 Hb及 Hct增加有關，可能有助於改善或預防化療所造成的貧血。化療前『肉類食物』或『減少烹調用油』頻率愈高，或化療後增加『吃足兩份水果』或『減少烹調用油』頻率，與 WBC或 Eosinophils 增加有關，應有助於提高免疫機能，預防感染。化療前『素食』或『牛奶』攝食頻率愈高，化療後增加『吃足兩份水果』頻率，與 Prealbumin或 Albumin增加有關，可能有助於提升蛋白質營養狀況。化療前『營養補充品』攝食頻率愈高，及化療後增加『蛋類』、『豆製品』、『保健食品』或『減少烹調用油』攝食頻率與IFN-、IL-1、IL-6或 TNF-增加有關。化療前『全穀類』及化療前後『有機或生機食品』攝食頻率愈高，與氧化壓力的增加（抗氧化能力下降或淋巴球 DNA 氧化傷害增加）有關，上述飲食行為對化療的實質影響，仍需進一步研究釐清。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、抗氧化能力和細胞激素的表現，可能也與化療過程中引發的併發症互有因果關係。本研究結論可用來評估或修正飲食因子來輔助化療所引發的副作用，做為醫院建立乳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 breast cancer patients receiving postoperative chemotherapy. Nutrition assessment and food intake were assessed with a patient-generated subjective global assessment (PG-SGA) and semi-quantitative 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 breast cancer patients. A commercially available enzyme-linked immunosorbent assay (ELISA) was used for quantitative detection of human cytokines IL-6, INF-γ, TNF-α and IL-1β. This survey was conducted before the chemotherapy and two weeks after the second chemotherapy. Twenty-eight patients participated in this study. The mean age was 53.7 ± 12.0 y and mean height was 157.5 ± 5.6 cm. The mean weight before the chemotherapy was 61.6 ± 12.8 kg. All patients had a histologically confirmed diagnosis of stages I to III breast cancer. 25.0％ of patients were stage I disease, 35.7％ were stage II and 39.2％ were stage III. Patients received chemotherapy could increase PG-SGA score, but decrease anemia indicators of RBC, Hb, Hct and MCHC, Immune inflammation indexes of WBC and eosinophils count, transferrin and zinc level. Under better nutritional condition, patients received chemotherapy had higher DNA oxidative damage. Higher intake frequency of “soybean products” before chemotherapy, or increased intake frequency of “enough to eat three servings of vegetables” after chemotherapy have a relationship with increased Hb and Hct level, which may improve or prevent anemia caused by chemotherapy. Higher intake frequency of “meat” or “reduce the cooking oil” before chemotherapy, or increased intake frequency of “enough to eat two servings of fruits” or “reduce the cooking oil” after chemotherapy, have a relationship with increased WBC and eosinophils count, which should enhance the immune functions and prevention from infections. Higher intake frequency of “vegetarian” or “milk” Before chemotherapy, or increased intake frequency of “enough to eat two servings of fruits” after chemotherapy, have a relationship with increased prealbumin and albumin level, which may help improving the nutritional status of protein. Higher intake frequency of “nutritional supplements” before chemotherapy, or increased intake frequency of “eggs”, “soybean products” , “health food” or “reduce the cooking oil” after chemotherapy, have a relationship with increased IFN-, IL-1, IL-6 or TNF- productions. Higher intake frequency of “whole grains” or “organic / non-toxic foods” before chemotherapy, or increased intake frequency of “organic / non-toxic foods” after chemotherapy, have a relationship with increased oxidative stress, such as decreased antioxidative capacity or increased lymphocyte DNA oxidative damage. However, the above eating behavior for the impacts of chemotherapy still need further research. 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 breast cancer patients.
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