口腔肿瘤术后患者放疗前中后期人体成分和生化指标的变化

Changes of body composition and biochemical indexes in patients with oral cancers before, during and after radiotherapy

目的 观察口腔肿瘤术后患者放疗前中后期的人体成分及生化指标的变化。 方法 选取上海交通大学医学院附属第九人民医院营养门诊就诊的口腔肿瘤术后患者66例,通过TANITAMC-180身体成分分析仪分别于放疗前2周、放疗中期、放疗后2周对患者体重、基础代谢率、骨骼肌肉量、体脂率等进行测定,检测血总蛋白、白蛋白、前白蛋白、肌酐等生化指标,采用SPSS23.0软件包对数据进行统计学分析。 结果 口腔肿瘤术后患者放疗后期体重、体质指数(BMI)、躯干和双上肢及总肌肉量较放疗前、中期下降,放疗中后期躯干和双上肢体脂率较放疗前显著上升(P<0.05)。放疗后期血清白蛋白、肌酐较放疗中期下降,放疗后期前白蛋白比放疗前、中期显著下降(P<0.05)。 结论 口腔肿瘤术后患者躯干及四肢肌肉量减少、肌肉蛋白丢失是体重下降的主要原因,对准备放疗患者应尽早进行营养干预和营养支持。

Objective To observe the changes of body composition and biochemical indexes in patients with oral cancers before,during and after radiotherapy. Methods Sixty-six patients with oral cancers treatedin Shanghai Ninth People's Hospital were selected.Body weight, body mass index, basal metabolic rate, skeletal muscle mass and body fat rate were measured by TANITA MC-180 body component analysis instrument 2 weeks before, during and 2 weeks after radiotherapy.Total protein, albumin, prealbumin, serum creatinine and other biochemical indexes were determined.SPSS 23. 0 software package was used for data analysis. Results Postoperative body weight, BMI, total muscle mass, trunk and upper extremity muscle mass of patients with oral cancers after radiotherapy were decreased compared with thosebefore and during radiotherapy, and the fat rate of trunk and upper extremity was significantly increased in the middle and late radiotherapy compared with that before radiotherapy (P<0.05).In the age group below 60 years old, the total muscle mass, the muscle mass of the trunk and the left upper limb in the later radiotherapy period decreased compared with thosein the early and middle radiotherapy period, and the fat rate of the left upper limb increased (P<0.05).The body weight, BMI and bilateral calf circumference of patients aged 60 and above in the later stage of radiotherapy were decreased compared with those in the middle stage of radiotherapy, and the total muscle mass, trunk and lower limb muscle mass in the later stage of radiotherapy were significantly decreased compared with thosein the early stage of radiotherapy (P<0.05).The serum albumin and serum creatinine in the postoperative period after radiotherapy were lower than those in the postoperative period after radiotherapy, and the prealbumin in the postoperative period after radiotherapy was significantly lower than those in the preoperative period and the postoperative period after radiotherapy (P<0.05).In the age group below 60 years old, albumin and prealbumin in the later stage of radiotherapy decreased significantly compared with thosebefore radiotherapy (P<0.05).The total protein, albumin and serum creatinine of patients aged 60 years and above decreased in the later stage of radiotherapy compared with the middle stage of radiotherapy, which was statistically significant (P<0.05). Conclusion The main reason of weight loss is the decrease of muscle mass and muscle protein in the trunk and limbs after oral tumor cancers.Nutritional intervention and nutritional support should be provided as early as possible for patients preparing for radiotherapy.