李静静 叶玉平 柯莽

[摘要] 目的 探討耳穴压豆联合营养干预治疗对晚期膀胱癌伴厌食患者血清瘦素和食欲素A水平的影响及疗效。 方法 选取2016年1月至2019年8月我院内科门诊或住院就诊的晚期膀胱癌伴厌食患者72例，采用随机数字法将患者分为联合组（n=36）和单用组（n=36）。单用组患者予以营养支持治疗，联合组患者在单用组基础上予以耳穴压豆治疗。两组患者均连用8周。比较两组患者治疗前后血清瘦素、食欲素A水平的变化，并比较其临床效果。 结果 治疗8周后，联合组患者血清瘦素水平较治疗前明显下降，血清食欲素A水平较治疗前明显上升（P<0.05），且治疗后联合组患者变化幅度高于单用组（P<0.05）;联合组患者临床总有效率（94.44%）高于单用组（77.78%）（χ2=4.180，P<0.05）。 结论 耳穴压豆联合营养干预治疗用于晚期膀胱癌伴厌食患者的效果明显优于单纯的营养干预，能促进患者进食，提高食欲，其作用机制可能与其能调节血清食欲调节因子，降低血清瘦素，提高食欲素A水平密切相关。

[关键词] 晚期膀胱癌;厌食;营养干预;耳穴压豆;瘦素;食欲素A

[Abstract] Objective To explore the effect of the therapy of auricular point pressing with beans combined with nutritional interventions （NI） on the levels of serum leptin and orexin-A in the patients with advanced bladder cancer （ABC） complicated with anorexia. Methods A total of 72 patients with ABC complicated with anorexia admitted to the outpatient service or hospitalized in Department of Internal Medicine of our hospital from January 2016 to August 2019 were selected and divided into the combined therapy group（n=36） and the monotherapy group（n=36） through random number method. The patients of the monotherapy group were given nutritional support， while the patients of the combined therapy group were treated with auricular point pressing with beans on the basis of what was given to the monotherapy group. For both groups of patients， the respective treatment lasted 8 weeks. The changes in the levels of serum leptin and orexin-A before and after treatment in the two groups of patients were observed and compared， and the clinical effects were also compared. Results After 8 weeks of treatment， the level of serum leptin in the patients of the combined therapy group was significantly lower than that before treatment，while the level of serum orexin-A was significantly higher than that before treatment（P<0.05）， and the range of changes in the patients of the combined therapy group was more obvious than that of the monotherapy group after treatment（P<0.05）.Meanwhile，the total clinical effective rate in the patients of the combined therapy group（94.44%） was superior to that of the monotherapy group（77.78%）（χ2=4.180， P<0.05）. Conclusion The effect of the therapy of auricular point pressing with beans combined with NI on the patients with ABC complicated with anorexia was obviously better than the monotherapy of NI. It can promote patients′ eating and increase their appetite. Its mechanism may be closely related to its ability to regulate appetite regulating factors in the serum， reduce the level of serum leptin and improve the level of orexin-A.

[Key words] Advanced bladder cancer; Anorexia; Nutritional interventions; Auricular point pressing with beans; Leptin; Orexin-A

膀胱癌是较常见的恶性肿瘤，2012年全国肿瘤登记地区膀胱癌的发病率为6.61/10万，发病率和死亡率均较高[1-2]。厌食是晚期肿瘤最常见的伴随症状，据统计发病率高达80%以上，主要表现为食欲下降或体重下降，严重时发生恶液质，缩短了患者的生存时间[3]。癌性厌食的病因及发病机制较复杂，近年来研究发现食欲素、瘦素等食欲调节因子在其发病中起着重要的作用[4-5]。营养支持是改善晚期肿瘤厌食患者营养状态，减轻厌食症状的主要手段，但长期的营养支持由于经济或患者依从性的原因，在临床上常受到限制[6]。耳穴压豆是一种中医外治方法，近年来研究发现其辅助营养支持具有减轻晚期肿瘤厌食症状，提高其营养状况的作用[7]，但其对血清食欲素、瘦素等食欲调节因子的调节作用国内外鲜有报道。……