| Objective This study aims to assess the effectiveness of the PG-SGA(Patients Generated Subjective Global Assessment) [1] related serologic in dicators as nutritional screening tools for patients with malignancy and a-nalyze the association between nutritional status and tumor related featu res, clinical related variables.By use of PG-SGA, we evaluate the therapeutic effect of medroxypro-gesterone in combination with Chinese caterpillar fungus formula for ea-rly intervention of patients with gastrointestinal malignant tumors.Methods A total number of 450 patients were chosen from Pu’ai Hosp-ital, Tongji College,Huazhong University of Science and Technology, whose diagnosis was during July,2013 to July,2014.The nutritional state of all enrolled patients were assessed by BMI(body max index) [2]and P-G-SGA.BMI evaluation criterion: underweight(BMI<18.5kg/m2), normal weight(BMI 18.5-24.9 kg/m2),overweight(BMI:25-29.9 kg/m2), obesity(B MI≥30 kg/m2) [3] PG-SGA standardized classification: well-nourished(SG A-A:0-3),middle malnutrition(SGA-B:4-8), severe malnutrition(SGAC:>8 分).Meanwhile, the overall nutritional state of these patients was evaluated by detection of serologic TP, Alb, PA and Hb.On this basis,72 patients with gastrointestinal tumors were selected for medroxyprogesterone and Chinese herbal formulas treatment,which were randomly grouped into experimental group(36 cases) and control group(36 cases).Experimental group features with medroxyprogesterone(500mg per time, twice times per day) and herbal formulas(cordyceps, cypress, poria cocos, liquorice)treatment,while the control group were treated medroxyprogesterone alone for 20 days. At the ti-me before treatment, at the time for treatment for 10 days, and At the time for treatment for 20 days, serum sample of these patients were collected and later analyzed by use of PG-SGA.Results Among 450 patients, 282 patients were overweight(62.7%), 151patients(33.5%) were in good nutritional state, whereas only 17 patients were malnutrition 3.8% by assessment of BMI. Nonetheless, according to assessment of PG-SGA, 319 cases were well-nourished(70.9%),131 c-ases were malnutrition(29.1%).Analyzed results based on two measur-ement were distinguished significantly(P=0.01).Results required adjustment for diagnoses: greater histological aggressiveness was found in overweight/obese prostate and breast cancer; und-ernutrition was associated with aggressive lung, colorectal, headneck, stomach, and esophageal cancers(P<0.005). Estimates of effect size reve-aled that overweight/obesity was associated with advanced stage(24%), aggressive breast(10%), and prostate(9%)cancers, whereas undernutrition was associated with more aggressive lung(6%), colorectal(6%), and head-neck(6%) cancers; in both instances, age and longer disease durati-on were of significance.By use of PG-SGA, we study the association between nutrition state and toxic reactions of chemotherapy. The analyzed data displayed that: i-ncidence rate of hematological toxicity(anemia, leucopenia, thrombocytopenia) was 82.9%(29/35) in malnutrition group, while incidence rate o-fhematological toxicity in well-nourished group was 40.9%(18/44), whi-ch were significantly different.(P=0.0002).In addition, incidence rate of nausea and vomiting, hepatic damage in malnutrition group were 82.9%(29/35),80.0%(28/35)respectively. Ho wever, incidence rate of nausea and vomiting, hepatic damage in wellno urished group were 45.6%(20/44),40.9%(18/44)respectively. The inci dence rate of nausea and vomiting,hepatic da-mage between these two group were significantly different(P=0.0007, P=0.0005 respectively).Thanks to medroxyprogesterone jointed herb treatment at day 10, nutri-ational related indicators, including TP, Alb, PA, Hb were all increased in both groups, however, values of TP, Alb in experimental group whe-n compared with control group(P<0.05).By the time of treating for 20 days, values of TP, Alb, PA were also higher than the control group(P<0.05).But Hb values in two groups demonstrated without significant di-fference(P>0.05).Conclusion By use of PG-SGA with serological indicators detection, we can accurately make a comprehensive assessment of nutritional stateof- patients with malignancy. Nutritional state of patients is closely related to clinicpathological stages, hematological toxicity of chemothrepy, gastr-ointestinal adverse reaction.Combined therapy of medroxyprogesteroneand herbal formulas for impro-vement of malnutrition, hematological andgastrointestinal toxicity are superior to single treatment of medroxyprogesterone. And the safety of me dicine, convenient, non-toxic side effect, it is worthy of popularization a nd application in clinical practice. |
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