蛋白质摄入水平在头颈肿瘤放化疗中的应用研究

Application study of protein intake in head and neck cancer patients undergoing radiotherapy

目的探讨蛋白质摄入量对头颈肿瘤患者根治性放化疗期间黏膜损伤和营养状况的影响。方法选取2018年7月至2019年12月南京大学医学院附属鼓楼医院收治的72例头颈肿瘤患者的临床资料进行前瞻性研究。采用数字随机表法将患者分为2组,根据剔除标准,最终干预组纳入患者32例[男性27例、女性5例,年龄(51.67±12.92)岁]、对照组29例[男性23例、女性6例,年龄(56.03±8.26)岁]。干预组在常规膳食基础上接受在院蛋白质补充方案[补充乳清蛋白粉50 g/d,使总蛋白质摄入量达1.5~2.0 g/(kg·d)];对照组采用在院常规膳食方案[蛋白质摄入量为1.0~1.2 g/(kg·d)]。所有患者均采用根治性同步放化疗方案。比较治疗前后2组患者的黏膜损伤程度、营养指标变化、治疗疗效和相关并发症。计数资料的比较采用四格表χ^(2)检验;两样本均数的比较采用成组t检验。结果2组患者在年龄、身高、血压、心率(t=-1.59~1.26)、性别、学历和病种(鼻咽癌与其他疾病)(χ^(2)=0.01~0.45)方面的差异均无统计学意义(均P>0.05)。在口腔黏膜损伤方面,干预组患者的损伤程度低于对照组[16%(5/32)对38%(11/29)],且差异有统计学意义(χ^(2)=3.913,P=0.04);在营养指标方面,干预组与对照组比较,除了骨骼肌、体脂肪和血红蛋白外,干预组在体重[(-2.80±2.66)kg对(-4.85±2.35)kg,t=3.18,P<0.01]、体重指数[(-1.00±0.95)kg/m^(2)对(-1.81±0.89)kg/m^(2),t=3.38,P<0.01]、握力[(5.59±4.20)kg对(2.59±5.32)kg,t=2.46,P=0.02]和血清白蛋白[(-1.40±3.37)g/L对(-3.07±2.92)g/L,t=2.06,P=0.04]指标的维持上均优于对照组。2组在疗效评价、腹泻、便秘和发热指标上的差异均无统计学意义(χ^(2)=0.24~1.30,均P>0.05)。结论在头颈肿瘤根治性放化疗中,补充蛋白质有缓解患者放射性黏膜损伤程度的作用,在保持患者营养指标上也具有优势。

Objective To explore the effects of strengthening protein on mucosal injury and nutritional status in patients with head and neck cancer undergoing radiotherapy.Methods A total of 72 patients with head and neck cancer admitted to Nanjing Drum Tower Hospital Cancer Center from July 2018 to December 2019 were involved in this prospective study.All patients were randomly divided into two groups according to the random number table.Eventually,32 cases(5 females,27 males,51.67±12.92 years old)were included in the intervention group,which accepted additional protein intake based on a conventional diet(50 g/d supplementary whey protein powder to reach the total protein of 1.5–2.0 g/(kg·d)),and 29 cases were included in the control group(6 females,23 males,56.03±8.26 years old),which treated with a conventional diet(the total protein of 1.0–1.2 g/(kg·d))according to the elimination criteria.All the patients were treated with radical concurrent chemoradiotherapy.The degree of mucosal damage,the change of nutritional indexes,therapeutic effect and related complications between the two groups were compared before and after treatment.The fourfold tableχ^(2) test was used in the comparison of enumeration data and group t test was used to compare the means of two samples.Results There were no statistically significant differences in age,height,blood pressure,heart rate(t=-1.59–1.26,all P>0.05),sex,education background and disease types(nasopharyngeal carcinoma and other diseases)(χ^(2)=0.01–0.45,all P>0.05)between the two groups.In terms of oral mucosal injury,the degree of injury in the intervention group was lower than that in the control group(16%(5/32)vs.38%(11/29),χ^(2)=3.913,P=0.04).In nutritional indicators,intervention group was better than the control group in maintaining weight[(-2.80±2.66)kg vs.(-4.85±2.35)kg,t=3.18,P<0.01],body mass index[(-1.00±0.95)kg/m^(2) vs.(-1.81±0.89)kg/m^(2),t=3.38,P<0.01],grip strength[(5.59±4.20)kg vs.(2.59±5.32)kg,t=2.46,P=0.02],serum albumin[(-1.40±3.37)g/L vs.(-3.07±2.92)g/L,t=2.06,P=0.04]except the skeletal muscle,body fat,hemoglobin.There was no significant difference between the two groups in efficacy evaluation,diarrhea,constipation,and fever(χ^(2)=0.24-1.30,all P>0.05).Conclusion Strengthening protein supplement can help effectively reduce the degree of mucosal injury and have advantages in maintaining the indexes of the nutritional status of head and neck cancer patients.