头颈部恶性肿瘤患者放疗前营养风险与营养不良状况分析

Analysis of nutritional risk and malnutrition in patients with head and neck cancer before radiotherapy

目的描述头颈部恶性肿瘤(head and neck cancer,HNC)放疗患者放疗前的营养状况,并分析其影响因素。方法采用便利抽样法,选取2017年3月至2019年6月于北京大学肿瘤医院放疗科门诊拟接受放疗的HNC患者为研究对象,在放疗前一天进行测评,测评内容包括一般资料、营养筛查和营养评定。营养筛查采用营养风险2002(nutritional risking screening 2002,NRS2002),营养评定采用营养不良评定标准全球领导人共识(global leadership initiative on malnutrition,GLIM),采用体成分仪进行肌肉量测定。结果共661名HNC患者纳入分析,28.7%患者存在营养风险,26.8%存在营养不良;诊断为营养不良的主要表现型指标为非意向性体质量丢失。多因素Logistic回归分析结果显示,年龄≥65岁、口腔癌和鼻腔鼻窦肿瘤的患者在放疗前更易存在营养风险和营养不良(P<0.05)。结论近30%HNC患者在放疗前就存在营养风险和营养不良;年龄和疾病部位是营养风险和营养不良的危险因素。为提高患者预后,医务人员应关注放疗前HNC患者的营养状况,尤其是老年患者、口腔和鼻腔鼻窦肿瘤患者。

Objective To describe the nutritional status of patients with head and neck cancer(HNC)before radiotherapy,and analyze their influencing factors.Methods The convenience sampling method was adopted to select HNC patients who were going to receive radiotherapy in the radiotherapy department of Peking University Cancer Hospital from March 2017 to June 2019.Data were collected the day before radiotherapy,including general information,nutritional screening and nutritional assessment.Nutritional Risking Screening 2002(NRS2002)was used as a nutritional screening tool,and the Global Leadership Initiative on Malnutrition(GLIM)was used as a nutritional assessment tool.Body Composition Analyzer was used to measure body composition.Results A totalof 661 HNC patients were included in the analysis,28.7%of the patients had nutritional risk,and 26.8%had malnutrition.The main phenotypic criterion of malnutrition was non-intentional weight loss.Multivariate Logistic regression analysis showed that patients aged≥65 years or oral cancer and sinus tumors were more likely to have nutritional risk and malnutrition before radiotherapy(P<0.05).Conclusion Nearly 30%of HNC patients had nutritional risk and malnutrition before radiotherapy.Age and tumor location are risk factors for nutritional risk and malnutrition.In order to improve the prognosis of patients,medical personnel should pay attention to the nutritional status of HNC patients before radiotherapy,especially elderly patients and patients with oral and sino-nasal neoplasm.