不同营养状态对鼻咽癌患者放疗期间毒副反应发生率的影响

Effects of Different Nutritional Status on the Incidence of Adverse Reactions of Nasopharyngeal Carcinoma Patients During Radiotherapy

目的探讨鼻咽癌患者放疗期间不同营养状态下毒副反应发生率的差异。方法选择2012年7月—2018年7月在我院首诊的184例鼻咽癌患者为研究对象,分别于放疗前、放疗中(第4周第1次放疗前)、放疗后记录患者体重,计算体重指数(BMI),采用患者主观评估量表(PG-SGA)评估其营养状态并进行分组,观察患者放疗期间营养状态的变化,并比较不同营养状态患者的放疗毒副反应发生率。结果鼻咽癌患者在放疗期间PG-SGA评级进行性升高、BMI进行性下降、血液营养指标进行性下降(P<0.05)。鼻咽癌患者营养状态越差,口腔黏膜炎(P=0.033)、口干(P=0.032)、吞咽困难(P=0.014)、味觉障碍(P=0.044)、疲劳(P=0.000)、骨髓抑制(P=0.000)及胃肠道反应(P=0.006)等放疗毒副反应的发生率越高,且程度越重。Spearman相关性分析发现,鼻咽癌患者PG-SGA评分与口腔黏膜炎(P=0.015)、口干(P=0.021)、吞咽困难(P=0.012)、疲劳(P=0.000)、骨髓抑制(P=0.000)及胃肠道反应(P=0.012)等放疗毒副反应的发生率呈负相关。结论鼻咽癌患者放疗期间营养状态进行性恶化,营养不良与放疗毒副反应发生率密切相关。

Objective To investigate the differences of adverse reactions incidence between nasopharyngeal carcinoma patients with different nutritional status during radiotherapy.Methods A total of 184 patients who were initially diagnosed with nasopharyngeal carcinoma in Ningde Hospital between July 2012 and July 2018 were enrolled in this study.Respectively record the body weight of patients before radiotherapy,during radiotherapy(before the first radiation in the fourth week)and after radiotherapy,and calculate their body mass index(BMI).Patients were divided into three groups according to the scores of patient-generated subjective global assessment(PG-SGA).Observe the changes of nutritional status of patients during radiotherapy,and compare the radiotherapy side effects between patients with different nutritional status.Results Nasopharyngeal carcinoma patients showed a progressive increase in PG-SGA score rating,a progressive decrease in BMI and a progressive decrease in blood nutritional indexes during radiotherapy(all P<0.05).Patients with worse nutritional status showed higher incidence of mucositis(P=0.033),xerostomia(P=0.032),dysphagia(P=0.014),dysgeusia(P=0.044),fatigue(P=0.000),myelosuppression(P=0.000)and gastrointestinal reaction(P=0.006).Spearman correlation analysis revealed that the PG-SGA score was significantly negatively correlated with mucositis(P=0.015),xerostomia(P=0.021),dysphagia(P=0.012),fatigue(P=0.000),myelosuppression(P=0.000)and gastrointestinal reaction(P=0.012).Conclusion Nasopharyngeal carcinoma patients had their nutritional status deteriorated progressively during the radiotherapy.Malnutrition was closely related to the adverse reactions of radiotherapy.