头颈部恶性肿瘤放射治疗患者放射性黏膜炎及其与营养状况的关系

Radiation induced mucositis and its relationship with nutritional status in head and neck cancer patients treated with radiotherapy

目的记录头颈部恶性肿瘤患者在放射治疗过程中的放射性黏膜炎发生情况,分析放射性黏膜炎对进食及体重的影响及其发生的影响因素。方法采用连续定点采样法,选取在北京大学肿瘤医院接受放射治疗的头颈部恶性肿瘤患者为研究对象,在放射治疗前、中和结束时收集数据,评估口腔和咽部黏膜炎的发生情况、进食相关疼痛和进食类型,同时测量体重。结果共202例患者完成三次测评,放射治疗中期,分别有43.5%和34.2%的患者患有中重度(≥2级)口腔黏膜炎和咽部黏膜炎,放射治疗结束时,分别有53.5%和51.5%的患者患有中重度口腔和咽部黏膜炎。口腔和咽部黏膜炎程度与进食疼痛、进食类型和体重均相关(P<0.05);肿瘤部位是影响黏膜炎的严重程度的主要原因(Waldχ^2=26.033和14.216,P<0.001)。结论放射性黏膜炎随放射治疗逐渐加重,黏膜炎与进食疼痛、进食类型改变和体重下降密切相关;不同部位发生黏膜炎的严重程度不同。应采取积极有效的防治措施,加强对患者不良反应、营养状况的管理。

Objective To describe the characteristics of radiation induced mucositis in patients with head and neck cancer(HNC)during radiotherapy,and analyze the effect of radiation induced mucositis on diet patterns and weight change and the influencing factors for radiation induced mucositis.Methods Patients with HNC treated with radiotherapy in one cancer hospital were recruited.Data were collected before,during and at the end of the radiotherapy,which included radiation induced oral and pharyngeal mucositis,pain during eating,diet patterns and weight.Results Two hundred and two patients were completely investigated and 43.5%and 34.2%of the patients suffered from moderate to severe(≥grade 2)oral mucositis and pharyngeal mucositis,respectively during the radiotherapy.At the end of radiotherapy,53.5%and 51.5%of the patients suffered from moderate to severe oral mucositis and pharyngeal mucositis(≥grade 2),respectively.Oral and pharyngeal mucositis were significantly correlated with pain during eating,diet patterns and weight(P<0.05).Tumor site was the main reason that affected the severity of mucositis(Waldχ^2=26.033,14.216;P<0.001).Conclusion Radiation induced mucositis was gradually aggravated with radiotherapy progress,which is closely related to pain during eating,change of diet patterns and weight loss.The severity of mucositis is related to the tumor site.Measures should be taken to strengthen the management of adverse reactions and nutritional status of patients.