头颈部肿瘤患者营养综合状况与急性放射毒性反应的关系

Relationship between Nutritional Status and Acute Radiotoxicity in Patients with Head and Neck Cancer

[目的]分析头颈部肿瘤患者放疗前的营养综合状况和急性放射毒性反应的关系。[方法]调查130例头颈部肿瘤患者放疗前的营养状况,分别在放疗前和放疗2周末、4周末、放疗结束时评价放射毒性反应。采用因子分析,建立营养评价综合模型;采用广义加性模型分析患者营养综合状况和急性放射毒性的关系。[结果]根据营养综合指标判断,入院时营养不良88例(67.7%),其中轻度47例(36.2%)、中度32例(24.6%)、重度9例(6.9%)。患者营养状况与放射性皮炎(t=-4.65,P<0.001),口腔干燥(t=-5.67,P<0.001),咽/咽喉炎(t=-2.67,P=0.008),疲劳(t=-4.01,P<0.001),厌食(t=-3.13,P=0.002)间存在线性关系,与吞咽困难(χ2=16.80,P<0.001),黏膜炎(χ2=3.65,P=0.037)存在某种曲线关系。[结论]头颈部肿瘤患者的营养综合状况与急性放射毒性反应之间存在着一定的相关性,营养不良的患者在放疗前应给予营养支持。

[Purpose] To investigate the relationship between preradiation nutritional status and acute radiotoxicity in patients with head and neck cancer. [Methods] Nutritional status before radio-therapy and acute radiotoxicity of 130 cases with head and neck cancer were prospectively surveyed. Radiotoxicities before radiation, 2 weeks and 4 weeks after beginning of radiation, and the end of radiation were assessed respectively. A comprehensive model was established to assess the nutritional status by factor analysis. Relationships between nutritional status and acute radiotoxicities were analyzed by generalized additive models. [Results] According to comprehensive evaluation index of nutritional status, malnourished cases were 88 （67.7%） before radiotherapy. Of all the malnourished cases, mild, moderate and severe were 47（36.2%）, 32（24.6%） and 9（6.9%） respectively. Linear relationships were found between nutritional status and radiation dermatitis （t=-4.65,P0.001）, xe- rostomia（t=-5.67,P0.001）, pharyngitis/laryngitis （t=-2.67,P=0.008）, fatigue（t=-4.01,P0.001）, apocleisis （t=-3.13,P=0.002）. Definite curve relationship was found between nutritional status and dysphagia（χ2=16.799,P0.001） or oral mucositis （χ2=3.653,P=0.037）. [Conclusion] Nutritional status is correlated to acute radiotoxicities in head and neck cancer patients. Malnourished patients should be offered nutritional support before radiotherapy.