口服营养支持在鼻咽癌放疗患者中的临床研究

Clinical study of oral nutrition in nasopharyngeal carcinoma patients treated with radiotherapy

目的探讨口服营养支持对鼻咽癌放疗患者营养状况及副反应的影响。方法鼻咽癌初治患者83例,放疗前NRs 2002评分<3分,随机分为营养支持组40例和无营养支持组43例,放疗后1周内再次行NRs 2002评分,比较两组的营养指标和放疗副反应情况。结果 83例鼻咽癌患者根治性放疗后NRs 2002评分≥3分者53例,营养风险发生率为63.9%,营养支持组营养不良发生率更低(52.5%vs 74.4%,P<0.05)。两组血红蛋白(Hb)、白蛋白(ALB)、淋巴细胞数(LYM)放疗后均有显著下降,但营养支持组放疗后的Hb、体重指数(BMI)较无营养支持组高,体重下降比例更低,差异均有统计学意义(P<0.05)。无营养支持组的2/3级口腔黏膜炎、咽食管炎发生率较营养支持组高,放疗疗程更长(P<0.05)。结论鼻咽癌放疗患者营养风险发生率较高,口服营养支持可以减少体重丢失,减轻急性放射性口咽黏膜反应,进而提高患者的生活质量和肿瘤控制率。因此口服营养支持是一种值得临床推广的方便、经济、有效的肠内营养方法。

Objective To investigate the effects of oral nutritional supplementation on nutritional status and side effects of nasopharyngeal carcinoma patients after radiotherapy. Methods A total of 83 nasopharyngeal carcinoma patients （Nutrition risk scores〈3） were assigned to oral nutrition support group（ONS-group, n=40） and non-oral nutrition support group （N-ONS-group, n=43）. Nutrition risk of these patients was assessed again by Nutritional Risk Screening 2002 （NRs2002） wthin 1 week after radiotherapy. Clinical data, nutritional index and adverse reaction were compared be- tween two groups. Results Nutritional risk was found in 53 casess of all patients（63.9%）, while the incidence of malnutrition was lower in ONS-group （52.5% vs 74.4%, P〈0.05）. Hemoglobin level （Hb）, albumin level （ALB） and lymphocyte count （LYM） were significantly decreased after radiotherapy in both groups, but Hb and body mass index （BMI） after radiotherapy in ONS-group were higher than that of N-ONS-group, and weight loss ratio was lower（P〈0.05）. N-ONS-group occurred more grade 2/3 radiation oropharyngeal mueosal toxicity, swallow esophagitis（P〈0.05）, and was longer in the course of radiotherapy because of the interruption of treatment （P〈O.05）. Conclusion The incidence of nutrition risk is higher in patients with nasopharyngeal carcinoima after radiotherapy. Oral nutrition supplymentation can reduce weight loss and the acute irradiation oropharyngeal mucosa toxicity, which may improve the quality of life of patients and tumor control rate. So oral nutritional supplymentation is a convenient, economical and effective method of enteral nutrition.