恶性肿瘤患者的营养不良风险和干预

Risk of malnutrition and nutrition intervention in patients with malignancies

恶性肿瘤患者存在营养不良的风险,其程度取决于肿瘤的类型、部位、大小、分期等。相对于非消化道和早期肿瘤,消化道和中晚期肿瘤对人体营养状况的影响更大。营养不良又与患者对肿瘤治疗的应答性、不良反应和生活质量相关;营养不良者的预后明显差于营养良好者。导致营养不良的因素除恶性肿瘤的局部作用、肿瘤产生的各类细胞因子导致的代谢异常和伴随抗肿瘤治疗的负性作用外,还包括患者对肿瘤的恐惧、焦虑、无望、疼痛和睡眠障碍等。不同恶性肿瘤对人体营养状况影响的共性主要表现为厌食、体质量下降和恶病质。目前,已将抗肿瘤治疗对患者生活质量和营养状况产生的正性影响视为与生存率同等重要;对伴有营养不良的肿瘤患者,在循证基础上提供营养干预已成为不可缺少的综合治疗措施之一,目的是改善功能和生活质量。营养干预主要包括处理厌食和供给营养素,尚无足够证据证实癌症患者需要特殊营养配方。

There exists risk of malnutrition in patients with malignancies. The degree of malnutrition depends on the characteristics of the malignancy, including the location, type, size, and TNM staging of the tumor. Patients with digestive tract malignancies or advanced malignancies may be more affected on the nutritional status, compared with those with non-digestive tract malignancies or early malignan- cies. Malnutrition is usually associated with the decreased therapeutic response, quality of life, increased adverse effects and poorer prognosis. The factors leading to the malnutrition in patients with malignancies include not only the local effects of the tumors, the metabolic abnormalities caused by various cytokines and negative effects from anti-cancer treatment, but also the fear, anxiety, hopelessness, pain and sleep disorder towards the malignancies. Various malignancies may result in common manifestations, including anorexia, weight loss and cachexia. Nowadays, the positive effect of anti-cancer treatment on the quality of life and nutritional status has been regarded as important as the survival rate. Providing the appropriate nutrition intervention on the basis of evidence which aims to improve the physical function and quality of life has been one part of the comprehensive treatment for the patients with malignancies. The nutrition intervention is consisted of the treatment of anorexia and nutrient supplement. Up till now, there has been no sufficient proof to validate the needs of special nutrition formula for the patients with malignancies.