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免疫治疗时代营养支持的意义

Impact of Nutritional Support on Antitumor Efficacy in the Era of Immunotherapy

  • 摘要: 尽管免疫治疗在实体瘤领域取得重要突破,但其疗效存在显著个体差异。约80%的肿瘤患者存在营养不良,该状态可通过多种机制影响免疫治疗效果,包括引起淋巴组织萎缩与T细胞储备下降、限制T细胞活化与扩增所需代谢底物、炎症微环境阻碍T细胞向肿瘤组织浸润,以及恶病质状态加速PD-1抗体清除等。临床研究证实,严重营养不良会显著削弱机体免疫应答能力,并增加免疫治疗相关毒性风险。因此,规范化的营养治疗对优化免疫细胞的储备、激活、扩增及浸润能力具有关键作用,有助于为免疫治疗建立良好的免疫基础。在此基础上,免疫营养治疗通过补充精氨酸、ω-3多不饱和脂肪酸和核苷酸等免疫营养素,可调节促炎介质分泌,促进T细胞活化与增殖,从而增强抗肿瘤免疫应答,延长患者生存期,并推动肿瘤治疗向多模式联合与精准化方向迈进。

     

    Abstract: Despite breakthroughs in immunotherapy for solid tumors, significant variations in treatment efficacy persist. Up to 80% of cancer patients suffer from malnutrition, which leads to: lymphoid atrophy and reduced T-cell reserves; deficiency of substrates required for T-cell activation and expansion; concurrent inflammation hindering T-cell infiltration into tumors; and cachexia accelerating PD-1 antibody clearance. Clinical studies confirm that severe malnutrition significantly impairs immune responses and increases the risk of treatment toxicity. Therefore, implementing standardized nutritional therapy is crucial for optimizing the reserve, activation, expansion, and infiltration capacity of immune cells, thereby providing a sound immune system foundation for immunotherapy. Immunonutrition therapy, by enhancing immunonutrients such as arginine, omega-3 polyunsaturated fatty acids, and nucleotides, reduces the secretion of pro-inflammatory mediators and promotes T-cell activation and proliferation. This enhances anti-tumor immune responses, prolongs survival, and advances cancer treatment towards multimodal combination and precision approaches.

     

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