肿瘤患者营养状况及对临床结局的影响

Nutritional status of patients with tumor and its effect on clinical outcomes

目的了解肿瘤患者的营养状况，评估营养不良对患者临床结局的影响，为患者的营养治疗提供科学依据。方法收集2014年6月至2014年8月，浙江省12家医院的肿瘤患者，采用NRS2002和2015年ESPEN提出的营养不良诊断标准评估肿瘤患者营养风险和营养不良的发生率，并记录患者实验室检查及营养治疗状况。结果收集肿瘤患者802例，肿瘤患者营养风险发生率为31.80%，营养不良发生率为17.70%，其中消化系统肿瘤患者营养风险和营养不良的发生率均高于非消化系统肿瘤患者；消化系统肿瘤患者体重、BMI及小腿围显著低于非消化系统肿瘤患者（P＜0.05）；肿瘤患者中NRS2002≥3分的患者营养治疗率为28.24%，NRS2002＜3分的患者营养治疗率为6.40%，差异有统计学意义（χ2=71.809，P＜0.01）；营养不良患者营养治疗率为26.06%，营养状况良好患者营养治疗率为10.61%，差异有显著性（χ2=28.235，P＜0.01）；有营养风险的肿瘤患者ICU住院时间、住院时间与住院费用均高于无营养风险的患者（P＜0.01）；营养不良的患者总住院时间高于营养良好的患者（t=2.984，P＜0.01），ICU住院时间和住院费用两组之间无统计学差异。结论肿瘤患者营养风险和营养不良发生率高，尤其是消化系统肿瘤的患者，但是患者的营养治疗率并不高，造成患者住院时间延长和住院费用增加，因此建议对肿瘤患者进行定期营养评估及监测，及时调整营养治疗方案，提高患者生活质量。

Objective The aim of this study was to understand the nutritional status in patients with tumor and evaluate theimpact of malnutrition on clinical outcomes, then provide scientific reference for nutritional support of patients. Methods Collect 802patients with tumor in 12 hospitals in zhejiang province, during June to August in 2014. The rate of nutritional risk and malnutritionwas respectively evaluated with NRS 2002 and 2015 ESPEN diagnostic criteria, biochemical indexes and nutrition therapy wererecorded. Results The incidence rate of nutrition risk was 31.80% and malnutrition was 17.70%, which was higher in gastrointestinaltumor than others. Weight and BMI were significantly lower in gastrointestinal tumor patients than in non-gastrointestinal tumorpatients (P<0.05); The ratio of nutrition therapy in the group of NRS 2002≥3 was 28.24%, and 6.40% in NRS 2002<3 (χ2=71.809,P<0.01). Nutrition therapy with malnutrition was 26.06% and 10.61% in well-nourished patients (χ2=28.235, P<0.01). Patientsat nutritional risk according to NRS 2002(score≥3) prolonged hospitalization days and costs (P<0.01) over which NRS 2002score<3. It’s the same as malnutrition except costs. The length of ICU and hospitalization costs was no signification between wellnourishedand malnutrition patients. Conclusions The ratio of malnutrition and nutritional risk were significantly higher in patientswith tumor, especially in gastrointestinal cancer. However, the nation of nutritional support was low, which cancer caused to prolonghospitalization days and costs. We should assess nutrition status in patients with cancer regularly and modify nutritional support toimprove the quality of their life.