口服营养补充对鼻咽癌放化疗患者近期营养状况及治疗耐受性影响

Effects of oral nutritional supplement on short-term nutritional status and treatment tolerance in locally advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy

目的探讨口服营养补充对接受放化疗的局部晚期鼻咽癌患者营养状态、治疗耐受性的影响。方法2016-2018年前瞻性随机入组114例患者,干预组58例、对照组56例。干预组从放疗起予口服肠内营养干预,对照组予常规饮食。治疗前中后分别收集体重、血象及营养评估资料等。结果放化疗期间患者体重进行性下降,对照组下降趋势更明显(P>0.05)。与对照组比,干预组放疗中断率更低(0︰7%,P=0.039),2程同步化疗完成率更高(78%∶64%,P=0.02),血清总蛋白、白蛋白稳定性也更高(P=0.003、0.001),但急性不良反应发生率组间相近(P>0.05)。治疗开始后营养筛查状况同样进行性下降,对照组NRS2002≥3分患者显著多于干预组(P<0.05);PG-SGA评估组间相近(P>0.05)。结论鼻咽癌放化疗中体重下降及营养不良风险逐步增加。口服营养补充能够提高治疗耐受性及血清蛋白稳定性,但在体重及短期营养评估方面未体现出明显优势。

Objective To explore the impact of oral nutritional supplements in the local advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy. Methods From 2016 to 2018, we prospectively collected 114 patients into our study, including intervention group (n=58) and control group (n=56). Patients in the intervention group were given oral nutritional supplements from the beginning of radiotherapy, while the control group patients were receiving usual diet care. We collected data of weight, hematological index and nutrition related information before, during and after treatments. Results All patients experienced weight loss during radiotherapy. The declining trend was more obvious in intervention group but with no statistical difference (P>0.05). Radiotherapy interruption was lower, completion rate of 2 cycles of concurrent chemotherapy was higher(78% vs 64%, P=0.02)and level of total serum protein and albumin was more stable (P=0.003, 0.001) in the intervention group. No difference was found in acute toxicities between the two groups (P>0.05). During the treatment period, the nutrition risk screening score declined, more patients with NRS 2002 ≥3 in the control group than the intervention group (P<0.05), while no statistically significant difference was found in PG-SGA between the two groups (P>0.05). Conclusions Oral nutritional supplements can improve treatment tolerance and keep the stability of serum protein level, nevertheless, it has no obvious advantage in maintenance of weight and short-term nutritional status.