两种营养筛查工具在鼻咽癌放疗病人营养评估中的价值及其与癌因性疲乏的相关性

The value of two nutritional screening tools in nutritional assessment of patients with nasopharyngeal carcinoma undergoing radiotherapy and their correlation with cancer related fatigue

目的:探讨病人主观整体营养状况评估量表(PG-SGA)、营养风险筛查2002(NRS-2002)在鼻咽癌(NPC)放疗病人营养评估中的价值及其与癌因性疲乏(CRF)的相关性。方法:选取2017年1月—2019年9月在我院就诊的77例NPC病人作为研究对象。于病人放疗前1周内、放疗2周后、放疗4周后、放疗6周后采用PG-SGA、NRS-2002对其进行营养筛查,采用多维疲劳症状量表(MFSI-SF)对其CRF进行评定。结果:NPC病人不同时间点的MFSI-SF、PG-SGA、NRS-2002得分及血白蛋白水平比较,差异均有统计学意义(均P<0.001),且各时间点两两比较,差异亦有统计学意义(均P<0.05)。放疗前1周内、放疗2周后、放疗4周后、放疗6周后病人PG-SGA得分与血白蛋白水平的一致性评价Kappa值依次为0.737(P<0.001)、0.506(P<0.001)、0.368(P<0.001)、0.384(P<0.001),NRS-2002得分与血白蛋白水平的一致性评价Kappa值依次为0.504(P<0.001)、0.319(P<0.001)、0.115(P=0.002)、0.026(P=0.354)。放疗前1周内、放疗2周后、放疗4周后、放疗6周后病人PG-SGA得分与MFSI-SF得分均呈正相关(r_(放疗前1周内)=0.848,r_(放疗2周后)=0.804,r_(放疗4周后)=0.750,r_(放疗6周后)=0.511),NRS-2002得分与MFSI-SF得分均呈正相关(r_(放疗前1周内)=0.763,r_(放疗2周后)=0.597,r_(放疗4周后)=0.511,r_(放疗6周后)=0.394)。结论:强化营养状态对CRF具有重要意义,PG-SGA是筛查接受调强放射治疗的NPC病人营养状态的首选工具。

Objective:To explore value of Patient-Generated Subjective Global Assessment(PG-SGA)and Nutritional Risk Screening 2002(NRS-2002)in nutritional assessment of patients with nasopharyngeal carcinoma(NPC)undergoing radiotherapy and their correlation with cancer related fatigue(CFR).Methods:A total of 77 NPC patients in our hospital from January 2017 to September 2019 were selected as research subjects.Nutritional status was screened by PG-SGA、NRS-2002 within 1 week before radiotherapy,2 weeks after radiotherapy,4 weeks after radiotherapy,and 6 weeks after radiotherapy.CRF was evaluated by Multidimensional Fatigue Symptom Inventory(MFSI-SF).Results:Differences among scores of MFSI-SF,PG-SGA,NRS-2002 and albumin concentration at different time points of NPC patients were statistically significant(all P<0.001),and differences between two groups at each time point were statistically significant(all P<0.05).Kappa value of consistency evaluation between PG-SGA scores and albumin concentration within 1 week before radiotherapy,2 weeks after radiotherapy,4 weeks after radiotherapy,and 6 weeks after radiotherapy were 0.737(P<0.001),0.506(P<0.001),0.368(P<0.001),0.384(P<0.001).And Kappa value of consistency evaluation between NRS-2002 scores and albumin concentration were 0.504(P<0.001),0.319(P<0.001),0.115(P=0.002),0.026(P=0.354).The patient's PG-SGA scores and MFSI-SF scores within 1 week before radiotherapy,2 weeks after radiotherapy,4 weeks after radiotherapy,and 6 weeks after radiotherapy were positively correlated(rwithin 1 week before radiotherapy=0.848,r_(2 weeks after radiotherapy)=0.804,r_(4 weeks after radiotherapy)=0.750,r6 weeks after radiotherapy=0.511),and NRS-2002 scores and MFSI-SF scores were positively correlated(rwithin 1 week before radiotherapy=0.763,r_(2 weeks after radiotherapy)=0.597,r_(4 weeks after radiotherapy)=0.511,r_(6 weeks after radiotherapy)=0.394).Conclusion:It had great significance for CRF to enhance nutritional status.And PG-SGA was the first choice for screening nutritional status of NPC patients undergoing intensity modulated radiation therapy.