恶性肿瘤病人营养状况的评价

Nutritional assessment of patients with cancer

目的 评价恶性肿瘤病人的营养状况。方法 测定恶性肿瘤病人的实际体重 (ABW )、身高和血清白蛋白(Alb)浓度 ;并查询健康时平时体重 (UBW )和理想体重 (IBW)。计算体质指数 (BMI)、实际体重与平时体重比 ( %UBW )、实际体重与理想体重比 ( %IBW )。符合下列标准之一为营养不良 :1.BMI <18.5 ;2 .%UBW或 %IBW≤ 90 %;3.血清Alb浓度 <35g/L。结果 根据 %UBW、%IBW、BMI和Alb标准判断的全组病人营养不良发生率分别为 34%、35 %、2 4%和 4%。根据 %IBW标准 ,Ⅰ和Ⅱ期、Ⅲ期、Ⅳ期病人的营养不良发生率分别为 :12 %、2 5 %、5 6 %。根据 %IBW和BMI标准 ,肝癌营养不良发生率分别为 6 1%和 41%、胰腺癌 5 7%和 42 %、胃癌为 5 2 %和 36 %、食道癌 48%和 2 8%、结肠癌 46 %和 31%、直肠癌 43%和 30 %、肺癌 35 %和 2 6 %、卵巢癌 2 9%和 2 7%、乳腺癌 13%和 6 %、恶性淋巴瘤 12 %和 8%。结论 消化系统肿瘤病人的营养不良发生率高。肿瘤分期越晚、营养不良发生率越高。肿瘤病人的营养评定应以营养状况变化为主要指标。

Objective To investigate the nutritional status in patients with cancer.Methods The actual body weight(ABW) ,height, and serum albumin(Alb) were determined. The usual body weight(UBW) and ideal body weight(IBW) was inquired. Body mass index(BMI),the percentage change in ABW(%UBW or %IBW) were calculated and compared with UBW or IBW. The patients with one of the following 4 parameters-BMI<18.5 ,%UBW≤90% , %IBW≤90%, and serum Alb<35g/L were diagnosed of malnutrition.Results 34% of all the patients with cancer suffered from malnutrition by %UBW, 35% by %IBW,24% by BMI,4% by serum Alb. The prevalence of malnutrition in patients with stageⅠ/Ⅱ,Ⅲ,Ⅳ was 12%,25%,56% by %IBW, respectively.According to %IBW and BMI,malnutrition occurred in 61% and 41% of the patients with liver cancer,57% and 42% gastric cancer,52% and 36% pancreatic cancer,48% and 28% esophagus cancer,46% and 31% colon cancer,43% and 30% rectal cancer,35% and 26% lung cancer,29% and 27% ovarian cancer, 13% and 6% breast cancer,12% and 8% lymphoma, respectively.Conclusion There is a high incidence of malnutrition in patients with cancer in digestive system. The later the disease stage, the higher the prevalence of malnutrition.Nutritional assessment of cancer patients should be based principally on nutritional change.