乳腺癌术后辅助化疗患者营养风险状况及其对化疗不良反应的影响

Nutritional risk status of patients receiving adjuvant chemotherapy after breast cancer surgery and its effects on chemotherapy

目的观察乳腺癌术后辅助化疗患者的营养风险状况及其对化疗不良反应的影响。方法选取营养风险筛查量表2002(nutritional risk screening 2002,NRS 2002)评分<3分的乳腺癌术后患者96例,化疗6个周期后再次评估,根据NRS2002评分,≥3分为营养风险组,<3分为无营养风险组,分析两组临床资料、营养风险状况、不良反应及住院天数。结果96例乳腺癌患者术后辅助化疗6个周期后,NRS 2002评分≥3分者39例,营养风险发生率为40.6%;两组患者月经情况、雌激素受体/孕激素受体(ER/PR)、人表皮生长因子受体2(cerb B-2)、细胞增殖指数(Ki-67)、临床分期、化疗药物相对剂量强度等临床资料比较,差异均无统计学意义(P均>0.05)。两组化疗前后血红蛋白、血白蛋白、总淋巴细胞计数、肱三头肌皮褶厚度等营养指标的差异均无统计学意义(P均>0.05);营养风险组体重指数(BMI)化疗前后比较差异有统计学意义(P<0.05),无营养风险组BMI化疗前后比较差异无统计学意义(P>0.05),化疗后两组BMI比较差异有统计学意义(P<0.05)。营养风险组Ⅲ级/Ⅳ级主要不良反应为中性粒细胞减少、血红蛋白减少、血小板减少、恶心呕吐、口腔黏膜炎、肝功能异常、疲乏等,其发生率及住院时间均高于无营养风险组(P均<0.05)。结论乳腺癌术后辅助化疗期的患者存在较高的营养风险发生率,及早评估和发现其营养风险,有助于预测患者的化疗风险,减少化疗不良反应的发生。

Objective To assess the nutritional risk status of patients receiving adjuvant chemotherapy after breast cancer surgery and analyze the effects of that status on chemotherapy. Methods A total of 96 patients receiving adjuvant chemotherapy after breast cancer surgery and with Nutritional Risk Screening 2002（NRS 2002）scores 3 were selected. After six cycles of chemotherapy,patients were re-evaluated and divided into a group at nutritional risk（NRS 2002≥3）and a group at no nutritional risk（NRS 20023）.The two groups were compared in terms of clinical data,nutritional status,adverse reactions and length of hospitalization. Results Among 96 patients who received 6 cycles of adjuvant chemotherapy after breast cancer surgery,39 had NRS 2002≥3 and the incidence of nutritional risk among these patients was 40.6%. The group at nutritional risk and the group at no risk were similar in terms of menstruation,expression of estrogen receptor/progestin receptor（ER/PR） and human epidermal growth factor receptor 2（cerb B-2）,cell proliferation index（Ki-67）,periodization and relative chemotherapy dose intensity（P〉0.05）. The two groups were similar in the following indicators（P〉0.05）,both before and after chemotherapy：hemoglobin,blood albumin,total lymphocyte count,and triceps brachii muscle skin fold thickness. Body mass index changed significantly as a result of chemotherapy in the nutritional risk group（P〈0.05）,with the body mass index after therapy being similar between the risk group and no-risk group（P〈0.05）. The two groups differed significantly in rates of neutropenia,hemoglobin decrease,thrombocytopenia,nausea and vomiting,oral mucositis,abnormal liver function,fatigue and other grade Ⅲ＋Ⅳ adverse reactions（P〈0.05）. Conclusion Early assessment of nutritional risk during adjuvant chemotherapy after breast cancer may reduce the occurrence of adverse reactions due to chemotherapy.