肠道屏障功能对消化道肿瘤化学治疗后不良反应及营养状况的影响

【摘要】 目的：评价肠道屏障功能指标（二胺氧化酶、D乳酸、内毒素）对消化道肿瘤化疗后常见不良反应发生率和营养状况变化的影响，确定肠道屏障功能指标对于化疗后不良反应和营养状态恶化的最佳预测值。方法：收集2019.9~2022.3安徽医科大学附属安庆第一人民医院收治的77例消化道肿瘤患者化疗前血清二胺氧化酶（DAO）、D乳酸（DLA）和内毒素（ET），化疗前后主观整体营养评估量表（PG-SGA）评分等临床资料。通过比较不同临床特征患者的DAO、DLA和ET水平差异来分析肠道屏障功能对化疗后不良反应和营养状态的影响。筛选对不良反应和营养状态恶化有影响意义的因素进行二元Logistic回归分析，使用受试者工作特征曲线（receiver operating characteristic curve，ROC）和约登指数确定DAO、DLA和ET对不良反应和营养状态恶化的最佳预测值。结果：骨髓抑制的发生不受DAO、DLA和ET水平影响。呕吐、腹泻和营养状态恶化患者，化疗前DAO和DLA更高（P<0.05）。化疗后腹泻和转氨酶升高患者，化疗前ET更高（P<0.001）。logistic回归分析，DAO、DLA、3个月内胃肠手术影响呕吐的发生（P<0.05）。DLA是化疗后腹泻的独立影响因素（P=0.001）。后程化疗和DLA增高是化疗后营养状态恶化的影响因素(P<0.05)。ROC曲线和约登指数显示，ET对于转氨酶升高最佳预测值17.36u/L（AUC=0.850；P<0.001)。DAO和DLA对呕吐的最佳预测值分别为10.47u/L、18.55mg/L（AUC=0.727；AUC=0.708；P<0.05）。DLA对腹泻的最佳预测值为17.63mg/L（AUC=0.920；P<0.001）。DLA对于营养状态恶化的最佳预测值为12.77mg/L（AUC=0.684；P=0.006），但特异性较低。结论 肠道屏障功能指标，对于化疗后呕吐、腹泻、转氨酶升高和营养状态恶化均有预测作用。化疗前检测肠道屏障功能，对于化疗不良反应的防治和全程营养管理具有积极的参考价值。

Effects of intestinal barrier function on adverse reactions and nutritional status of patients with gastrointestinal tumor after chemotherapy

[Abstract] Objective To evaluate the effects of intestinal barrier function indexs on common adverse reactions and nutritional status of patients with gastrointestinal tumor after chemotherapy and to determine the best predictive value of intestinal barrier function detective indicators for them. Methods 77 patients in our hospital from 2019.9 to 2022.5 with gastrointestinal tumors were included.Their diamine oxidase (DAO), D-lactic acid (DLA) ,Endotoxin (ET) before chemotherapy, pre-chemotherapy and post-chemotherapy subjective global assessment scale (PG-SGA) scores and other clinical data were collected. By comparing the differences between DAO, DLA and ET, we analyze the influence of astrointestinal function to adverse reactions and nutritional status after chemotherapy. The meaningful indicators on adverse reactions and nutritional deterioration were screened for binary logistic regression analysis. The receiver operating characteristic curve (ROC) and Youden index were used to determine the best predictive value of DAO, DLA and ET for adverse reactions and nutritional deterioration.Results The occurrence of myelosuppression was not affected by DAO, DLA and ET levels.Patients with vomiting, diarrhea and worsened nutritional status had higher DAO and DLA before chemotherapy (P<0.05). Patients with diarrhea and elevated transaminase after chemotherapy had higher ET before chemotherapy (P<0.001). Logistic regression analysis showed that DAO, DLA and gastrointestinal surgery within 3 months affected the occurrence of vomiting (P<0.05).DLA is an independent influence factor of diarrhea after chemotherapy (P=0.001).Subsequent chemotherapy and increased DLA were the factors contributing to the deterioration of nutritional status after chemotherapy (P<0.05). ROC curve and Youden index showed that the best predictive value of ET for transaminase elevation is 17.36U/L(AUC=0.850;P<0.001). The best predictive value of DAO and DLA for vomiting are 10.47U/L and 18.55mg/L (AUC=0.727;AUC=0.708;P<0.05)respectively.The best predictive value of DLA for diarrhea is 17.63mg/L(AUC=0.920;P<0.001).The best predictive value of DLA for nutritional deterioration was 12.77mg/L(AUC=0.684;P=0.006), but the specificity was low.Conclusion Intestinal barrier function indicators have predictive effects on vomiting, diarrhea, elevated transaminases, and deterioration of nutritional status after chemotherapy. Detecting intestinal barrier function before chemotherapy has a positive reference value for predicing adverse reactions of chemotherapy and nutrition management throughout the process.