粒子放疗鼻咽癌患者营养状况变化及影响因素分析

Nutritional status changes and influencing factors in patients with nasopharyngeal carcinoma undergoing particle radiotherapy

目的 了解粒子放疗鼻咽癌患者营养状况的变化以及严重体重丢失的影响因素。方法 回顾性研究2016年10月—2021年9月期间在上海市质子重离子医院接受质子重离子治疗的鼻咽癌患者740例。收集基本信息、诊疗方案和营养指标等。采用配对t检验分析质子重离子治疗前后患者营养状况的变化,多因素Logistic回归分析严重体重丢失(critical weight loss, CWL)的影响因素。结果 本组患者入院时营养不良44例(6.0%);营养风险132例(17.8%);放疗期间CWL的发生率为42.2%。分析显示,重离子放疗对营养风险和体重影响不明显(P>0.05);质子加重离子治疗以及光子加重离子治疗后营养风险分别增加了43.6%和64.4%;体重分别下降(3.19±2.65) kg和(5.04±2.73) kg;血清白蛋白分别下降(2.74±3.56) g/L和(2.91±3.49) g/L;总淋巴细胞计数分别下降(1.04±0.52)×10^(9)/L和(1.08±0.48)×10^(9)/L。Logistic回归分析显示,放疗方案、同期化疗、文化程度、心理痛苦等影响CWL。与单纯重离子治疗比较,质子加重离子和光子加重离子CWL发生增加(OR=33.37,95%CI:12.52~88.95;OR=107.50, 95%CI:40.20~287.44);同期化疗患者CWL增加(OR=2.04,95%CI:1.22~3.41);此外,与小学及以下文化程度比较,中学和大学及以上文化程度CWL发生增加(OR=3.54,95%CI:1.37~9.10;OR=4.42, 95%CI:1.70~11.48);与无心理痛苦比较,轻度心理痛苦患者CWL反而降低(OR=0.58,95%CI:0.38~0.88)。结论 单纯重离子治疗对鼻咽癌患者的营养状况影响不明显,质子加重离子治疗对营养和CWL的影响轻于光子加重离子治疗。

Objective To investigate the nutritional status changes and its influencing factors in patients with nasopharyngeal carcinoma treated with particle radiotherapy.Methods Clinical data of 740 patients with nasopharyngeal carcinoma who received proton and heavy ion therapy from October 2016 to September 2021 were retrospectively analyzed.Paired t test was used to analyze the nutritional status of patients before and after particle radiotherapy,and multivariate Logistic regression was used to analyze the influencing factors of critical weight loss(CWL).Results There were 44 patients with malnutrition on admission,accounting for 6.0%;132 patients with nutritional risk,accounting for 17.8%;the incidence of CWL during radiotherapy was 42.2%.The analysis showed that heavy ion radiotherapy had no significant impact on nutritional risk and body weight(P>0.05).After proton plus heavy ion therapy and photon plus heavy ion therapy,the nutritional risk increased by 43.6%and 64.4%,body weight decreased by(3.19±2.65)kg and(5.04±2.73)kg,serum ALB decreased by(2.74±3.56)g/L and(2.91±3.49)g/L,and TLC decreased by(1.04±0.52)×10^(9)/L and(1.08±0.48)×10^(9)/L,respectively.Logistic regression analysis showed that compared with the heavy ion radiotherapy,the CWL of proton plus heavy ions and photon plus heavy ions increased(OR=33.37,95%CI:12.52-88.95;OR=107.50,95%CI:40.20-287.44),patients with concurrent chemotherapy increased CWL(OR=2.04,95%CI:1.22-3.41);compared with the education level of primary school and below,the incidence of CWL increased in in patients with education level of middle school and university education(OR=3.54,95%CI:1.37-9.10;OR=4.42,95%CI:1.70-11.48);compared with no psychological distress,patients with mild psychological distress had lower CWL(OR=0.58,95%CI:0.38-0.88).Conclusion Heavy ion radiotherapy alone has no significant impact on the nutritional status of patients with NPC,buy photon plus heavy ion therapy gives severe impact on nutrition status and leads to CWL,the nutritional impact of proton plus heavy ion therapy is less.