头颈部恶性肿瘤放射治疗患者味觉改变的纵向研究

Taste alteration of head and neck cancer patients treated with radiotherapy： A longitudinal study

目的 研究头颈部恶性肿瘤（HNC）患者放射治疗相关味觉变化及其与营养状况的关系.方法 采用连续定点采样方法,选取2017年3至1 1月于北京大学肿瘤医院放疗科接受放射治疗HNC患者172例,其中完成所有随访86例,采用化学治疗相关味觉改变量表中文版,在放射治疗前、放射治疗中期、放射治疗结束和放射治疗结束后1～2个月分别测评患者味觉情况,同时采用患者参与主观整体评定（PG-SGA）测评患者的营养状况.采用广义估计方程分析味觉改变的影响因素及其与营养状况的关系.结果 86例患者在放射治疗前、放射治疗中期、放射治疗结束和放射治疗结束后1～2个月,味觉改变的发生率分别为9.3％、84.9％、94.2％、77.9％;味觉改变随放射治疗进程逐渐加重,放射治疗结束时达高峰,放射治疗结束后1～2个月缓解,但仍未恢复至放射治疗前水平.PG-SGA评分随放射治疗进程逐渐增加,至放射治疗结束,95.3％的患者出现重度营养不良;随访时,仍有45.3％的患者存在重度营养不良.营养状况与味觉改变密切相关.累计放射治疗剂量和同步化学治疗是味觉改变的影响因素.结论 HNC患者味觉受放射治疗影响,随放射治疗剂量的增加,味觉改变逐渐加重,PG-SGA评分逐渐增加,患者营养不良问题越发突出.该影响可持续至放射治疗结束后一段时间,应引起重视并采取相应措施预防或减轻该影响,以避免味觉改变导致患者营养不良持续存在.

Objective To investigate the taste alteration caused by radiotherapy and its relationship with nutritional status in head and neck cancer patients during and after radiotherapy.Methods From March to November 2017,172 patients with head and neck cancer receiving radiotherapy were recruited from Beijing Cancer Hospital including 86 patients completing all follow up visits.Chemotherapy-induced Taste Alteration scale was used to evaluate radiotherapy-induced taste alteration and the Patient-generated subjective global assessment （PGSGA） was used for nutrition evaluation at baseline,mid-treatment,post-treatment and 1-2 months after radiotherapy （follow-up）.Generalized estimating equations was applied to analyze the influencing factors of taste alteration and its relationship with nutritional status.Results The incidence of taste alteration were 9.3%,84.9%,94.2% and 77.9% respectively at baseline,mid-treatment,post-treatment and 1-2 months after radiotherapy （follow-up）.Taste alteration score increased with the increase of radiation dose,reached the highest at the posttreatment and decreased at follow-up visit which was still higher than the score at baseline.PG-SGA score increased with the increase of radiation dose.The incidence of severe malnutrition after radiotherapy was 95.3%,decreased to 45.3% at follow up visit.Nutritional status was closely related to taste alteration.Total radiation dose and concurrent chemotherapy were the influencing factors of taste alteration.Conclusions The taste of patients with head and neck cancer is affected by radiotherapy.As radiotherapy continues,the taste alteration aggravates and PG-SGA score increases gradually,thus malnutrition becomes a prominent problem.Such effect will persist for a period of time after radiotherapy,which should be paid attention and interventions should be conducted to prevent or reduce this effect,in order that the lasting of malnutrition induced by taste alteration can be avoided.