| Background Factors like changes of anatomical structure and physiological function, inadequate nutrient intake caused by reduction of digestion and absorption area, intestinal malabsorption, loss increased and drug nutrient interactions can lead to decrease of reserve capacity of the body, metabolism and immune function in patients after gastrointestinal cancer surgery. These patients are prone to malnutrition, water and electrolyte and acid-base balance disorder, metabolic disorders. Patients after gastrointestinal cancer surgery have a higher incidence of malnutrition. Improvement of patients with malnutrition can increase patients’ quality of life, reduce malnutrition-related complications. Therefore, nutritional risk is screened to improve nutritional status of patients after gastrointestinal cancer surgery with early nutrition intervention. It is an important link in the treatment of patients after gastrointestinal cancer surgery.The tools used commonly in the assessment of malnutrition is the Subjective Global Assessment(SGA), Malnutrition Universal Screening Tool(MUST), Mini Nutritional Assessment(MNA), but these tools generally do not apply to hospitalized patients. Based on a lot of evidence on the basis of evidence-based medicine, Nutritional Risk Screening2002(NRS2002) was introduced by the European Society of Potential and Enteral Nutrition (ESPEN) in2002. NRS2002can provide a reasonable basis for nutritional support and judge the changes in nutritional status of patients. It is recommended for clinical application in Europe and our nation.In recent years, the reports of nutritional assessment on perioperative patients of gastrointestinal cancer surgery are gradually increasing. The correlated analysis has not been reported between nutritional risk screening and clinical features of patients after gastrointestinal cancer surgery more than one year.Objective This study adopted NRS2002to screen the nutritional risk of hospitalized patients after gastrointestinal cancer surgery, and analyze the correlation between nutritional risk and clinical features of patients after gastrointestinal cancer surgery more than one year.Methods133hospitalized patients after gastrointestinal cancer surgery and25healthy volunteers were collected at Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University from February2009to December2011. NRS2002is used to screen the nutritional risk.Results The incidence of Nutritional risk evaluated by NRS2002is80.45%(107/133) of all133hospitalized patients after gastrointestinal cancer surgery. The nutritional risk was80%in postoperative esophagus cancer group,88.16%in postoperative gastric cancer group,58.82%in postoperative colon cancer group,66.67%in postoperative rectal cancer. According to univariate analysis, the nutritional risk is associated with age, surgical site, accompanied by the disease, concomitant medications, BMI, and hemoglobin, albumin, alpha-fetoprotein, carcinoembryonic antigen, glycoprotein tumor markers related to19-9(P<0.05), and is not associated with gender, course of disease, smoking, alcohol. Conclusions NRS2002contribute to identify nutritional risk in hospitalized patients after gastrointestinal cancer surgery; It is correlated with nutritional risk of hospitalized patients after gastrointestinal cancer surgery and the clinical features including age, surgical site, accompanied by the disease, concomitant medications, BMI, and hemoglobin, albumin, alpha-fetoprotein, carcinoembryonic antigen, glycoprotein tumor markers related to19-9. Objective Patients after gastrointestinal cancer surgery are prone to osteoporosis. The exact pathogenesis of gastrointestinal cancer surgery-related OP has not been elucidated, which may be related to age, sex, malnutrition, abnormal absorption and intake of calcium and phosphorus, vitamin D deficiency, tobacco and alcohol history, history of gastrointestinal tract resection. There are studies shown that bone metabolism index in patients after gastrointestinal cancer surgery contributes to predict the bone mineral density (BMD) loss and fractures in patients after gastrointestinal cancer surgery. There are not yet studies about the level of bone metabolic markers which could assess the bone metabolism status of patients after gastrointestinal cancer surgery.Methods All clinical data of106patients after gastrointestinal cancer surgery confirmed by pathology were collected, which was the same to Part1, the level of urinary deoxypyridinoline (DPD) and serum osteocalcin (OC) were examined by enzyme-linked immunosorbent adsorption (ELISA) and25normal subjects as control, while urinary creatinine adjusted urinary DPD, respectively, and the correlation was analyzed between the clinical features and nutritional risk of postoperative of gastrointestinal cancer surgery. Results The level of urinary DPD/Cr in patients after gastrointestinal cancer surgery was significantly higher than that in the control group[16.48±7.12nmol/mmoL Cr vs5.15±2.49nmol/mmoL Cr, P<0.05], the level of serum OC in patients after gastrointestinal cancer surgery was significantly lower than that in the control group[1.24±0.31ng/mL vs2.88±1.53ng/mL, P<0.05] and the difference of serum. According to Nutritional Risk Screening2002(NRS2002), the level of urinary DPD/Cr in patients after gastrointestinal cancer surgery was significantly difference between positive and negative nutritional risk group [17.62±8.33nmol/xmol Cr vs11.86±2.66nmol/mol Cr, P<0.05]. According to surgical site, the levels of serum OC in patients between upper and lower gastrointestinal cancer surgery groups were significantly difference (P<0.05).Conclusions (1) The level of urinary DPD/Cr is higher than the normal control group, serum OC is lower between patients after gastrointestinal cancer surgery and the normal control group;(2) The level of urinary DPD/Cr and serum OC contributes to assessing the overall status of bone metabolism in patients after gastrointestinal cancer surgery(3) It is correlated with urinary DPD/Cr, serum OC levels and the clinical features including the severity, the extent of colonic involvement and nutritional risk. Objective Hey is a sulfur-containing amino acid produced as an intermediate product in the metabolism of the essential amino acid methionine. Hey can occur from the oxidation of thiol to produce oxygen free radicals and induce cardiovascular and cerebrovascular diseases by damaging vascular endothelium and promoting thrombosis. It has been demonstrated that plasma levels of Hey are mainly influenced by nutrition status of FA, VitB12, and by genetic polymorphisms of key enzymes of its metabolism. Factors like changes of anatomical structure and physiological function, inadequate nutrient intake caused by reduction of digestion and absorption area can lead to nutrient malabsorption in patients after gastrointestinal cancer surgery, particularly the absorption of vitamin, which leading to hyperhomocysteinemia.Studies show that patients after after gastrointestinal cancer surgery are prone to hypercoagulable states and thrombosis. Whether hyperhomocysteinemia occur in patients after gastrointestinal cancer surgery more than one year? Studies report that administration of folate and vitamin B12can reduce the level of plasma Hey in patients of cardiovascular and cerebrovascular diseases. Whether after gastrointestinal cancer surgery more than one year? This study is aim to investigated the clinical correlation among the level of plasma homocysteine(Hcy), folate(FA), vitamin B12(VitB12) in patients after gastrointestinal cancer surgery and control through investigating and analyzing the clinical characteristics of patients after gastrointestinal cancer surgery. The study is also investigate whether the level of Hcy changed after administration of folate and vitamin B12.Methods106hospitalized patients after gastrointestinal cancer surgery confirmed by pathology and25healthy volunteers were collected at Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University from February2009to December2011.106anticoagulated blood and urine samples were collected from the patients after gastrointestinal cancer surgery and25healthy volunteers.26patients after gastrointestinal cancer surgery are administrated with FA(5mg/d)and VitB12(0.5mg/d) for3month and then the anticoagulated blood and urine samples were also collected. The level of plasma Hcy in106cases of patients after gastrointestinal cancer surgery,26follow-up cases and25controls were detected by HPLC-FD method. The level of plasma FA and VitBi2in patients after gastrointestinal cancer surgery and controls were detected by enzyme-linked immunosorbent assay (ELISA) method.Results The level of plasma Hcy in patients after gastrointestinal cancer surgery groups was significantly higer than the level of control [11.41±7.46nmol/mol Cr vs8.19±4.81nmol/mol Cr, P<0.005]. According to the surgical site, the levels of plasma Hcy were divided into four groups:postoperative of esophagus cancer (18.24±7.33umol/L) postoperative of gastric cancer (9.33±5.22umol/L), postoperative of colon cancer (12.91±8.13umol/L), postoperative of rectal cancer (9.36±6.27umol/L), and the difference of plasma Hcy levels among the four groups was not statistically significant. The levels of plasma FA and VitB12in patients after gastrointestinal cancer surgery were both lower than that in the control[7.64±1.95nmol/L vs9.14±1.23 nmol/L,P<0.05]、[108.64±32.22pmol/L vs112.64±33.33pmol/L,P<0.05]. As the critical value of15.00umol/L, the levels of plasma Hey were divided into hyperhomocysteinemia and no hyperhomocysteinemia. Patients after gastrointestinal cancer surgery with hyperhomocysteinemia had lower FA, VitB12levels than non-hyperhomocysteinemia group[7.13±1.82nmol/L vs8.10±1.98nmol/L, P＜0.05]、[105.57±36.50pmol/L vs111.40±27.99pmol/L, P<0.05].Hcy levels in patients of follow-up group were lower than that before treatment, but there was no significant difference between the two groups.Conclusions (1) Patients after gastrointestinal cancer surgery had significantly higher Hey level than health control. The levels of plasma FA and VitB12were significantly lower in group of patients after gastrointestinal cancer surgery than that of the health control.(2) The levels of plasma FA and VitB12were lower in patients with hyperhomocysteinemia than non-hyperhomocysteinemia, which may be related to reduction of FA and VitB12.(3)The levels of plasma Hcy in patients after gastrointestinal cancer surgery administrated with FA and VitB12for3months were lower than that in before treatment, which suggest that treatment of FA and VitB12may reduce the level of Hey in the body. |
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