摘要
目的 评价局部晚期鼻咽癌患者放疗过程中营养支持疗法的疗效,探索影响营养状态的因素.方法 回顾性分析浙江省肿瘤医院2015年12月至2016年3月117例经病理组织学确诊的初治局部晚期（Ⅲ～ⅣB）鼻咽癌患者,所有患者均接受根治性放化疗.根据放疗过程中是否进行营养支持疗法,将患者分为对照组和营养疗法组,通过重复测量方差分析观察两组患者放疗前（T0）、放疗中（T1）、放疗后（T2）营养指标的变化,同时比较两组患者同一时期的营养状态.再根据体质量下降是否超过5％,将全组患者分为对照组（体质量下降≤5％）和营养不足组（体质量下降＞5％）,通过Logistic回归分析引起体质量下降的影响因素.结果 117例局部晚期鼻咽癌患者在放疗过程中全组患者的各项营养指标包括体质量、体质量指数、白蛋白、前白蛋白、营养免疫预后指数均显著恶化（T2比T0,T1比T0,均P＜0.001）.而同一时期,对照组和营养支持组的体质量、白蛋白、前白蛋白、营养免疫预后指数均无差异（P均＞0.05）,但营养支持组的放疗总时间较对照组短（45.8d比46.0d,P=0.023）.Logistic回归分析显示,放射性口腔黏膜炎≥Ⅲ度是营养受损的危险因素（比值比=3.232,P=0.021;95％ CI=1.198～8.820）;前白蛋白下降＞15％的患者出现营养受损的风险明显增加（比值比=2.442,P=0.041;95％ CI=1.036～5.757）.结论 放射性黏膜炎≥Ⅲ度可进一步加重局部晚期鼻咽癌患者放疗过程中营养受损的程度,前白蛋白下降＞15％与体质量下降具有明显相关性,目前现有的营养支持并不能够改善放疗过程中患者营养受损的状态.
Objective To evaluate the impact of nutritional therapy during radiotherapy for patients with locoregionally advanced （Ⅲ-ⅣB） nasopharyngeal carcinoma （NPC） and identify factors that might influence nutritional status of the patients.Methods We retrospectively reviewed 117 patients with locoregionally advanced NPC （Ⅲ-ⅣB） treated with radical radiotherapy between December 2015 and March 2016 at Zhejiang Cancer Hospital.The patients were grouped into those who received nutritional therapy and those who did not during radiotherapy.Chi-square test was used for both inter-and intra-group comparison of nutritional status before （T0）,during （T1） and after radiotherapy （T3）.The patients were then grouped into those who experienced substantial weight loss （＞5％） and those who did not （≤5％）,and Logistic regression was used to analyze factors that were potentially correlated with weight loss.Results Nutritional indicators were all on the decrease （T2 vs.T0,T1 vs.T0,P＜0.001）,including weight,body mass index （BMI）,albumin,pre-albumin （PA）,and prognostic nutritional index （PNI）.There was no significant difference between the group who received nutritional therapy and the one who did not in weight,albumin,PA,and PNI at a given time point （P＞ 0.05）,but patients in nutritional therapy group completed radiotherapy in fewer days than those in the control group （45.8 d vs.46.0 d,P=0.023）.Logistic regression revealed that patients with radiation-induced oral mucositis of grade≥3 （Odds ratio=3.232,P=0.021,95％ CI=1.198-8.820） and drop of pre-albumin by ＞15％ （Odds ratio=2.442,P=0.041,95％ CI=1.036-5.757） had greater risk of developing nutritional impairment.Conclusions Radiation-induced oral mucositis of grade≥3 might lead to deteriorating nutritional impairment in patients with locoregionally advanced NPC during radiotherapy,and drop of pre-albumin by ＞ 15％ was correlated with weight loss.Current nutritional support fell short of improving nutritional impairment during radiotherapy.
作者
李佩静
李凯新
金厅
黄爽
陈晓钟
陈明
胡巧英
陈媛媛
Li Peijing, Li Kaixin, Jin Ting, Huang Shuang, Chen Xiaozhong, Chen Ming, Hu Qiaoying, Chen Yuanyuan(Department of Radiation Oncology, Zhefiang Cancer Hospital; Zhejiang Key Laboratory of Radiation Oncology , Hangzhou 310022, Chin)
出处
《中华临床营养杂志》
CAS
CSCD
2018年第2期67-73,共7页
Chinese Journal of Clinical Nutrition
基金
国家自然科学基金（81672971）
浙江省医药卫生一般研究计划（面上）（20182448552）
关键词
鼻咽癌
放疗
营养支持
体质量下降
Nasopharyngeal carcinoma
Radiotherapy
Nutritional support
Weight loss
作者简介
通信作者:陈嫒媛,E-mail:chenyy@zjcc.org.cn
