慢性放射性小肠损伤的营养状况调查及危险因素分析

Investigation of nutritional status and risk factors of chronic radiation intestinal injury

目的:调查慢性放射性小肠损伤病人营养不良的发生情况并分析其危险因素,为慢性放射性小肠损伤病人制定营养疗法计划提供依据。方法:收集分析108例慢性放射性小肠损伤病人基础临床资料,采用NRS2002营养风险筛查工具和营养不良评定标准共识(GLIM)进行营养状况评定。根据评定结果将病人分为营养不良组和非营养不良组。采用多因素Logistic回归分析慢性放射性小肠损伤病人营养不良的危险因素。结果:108例慢性放射性小肠损伤病人中69.4%(75/108)为营养不良。单因素分析显示,距离放疗结束时间长、临床症状严重和消化道症状持续时间长会导致病人营养不良发生率增高[82.7%(62/75)vs 57.6%(19/33),χ^(2)=7.695,P=0.006;83.8%(62/74)vs 40.6%(13/32),χ^(2)=1570.5,P=0.004;89.3%(50/56)vs 60.9%(14/23),χ^(2)=8.559,P=0.003]。多因素分析证实,RTOG/EORTC≥Ⅲ级(P=0.003,OR=2.661,95%CI:1.400~5.055)以及消化道症状持续时间≥1个月(P=0.003,OR=8.195,95%CI:2.025~33.161)是导致营养不良的独立危险因素。结论:慢性放射性小肠损伤病人普遍存在营养不良,且与消化道症状持续时间和严重程度密切相关。应为病人建立长期营养指导和随访计划,避免病人长时间暴露于营养风险和营养状况受损中。

Objective:To investigate the incidence of malnutrition in patients with chronic radiation enteropathy,analyze its risk factors,and provide a basis for developing nutritional therapy plans.Methods:To review the clinical data of 108 patients with chronic radiation enteropathy,using the NRS 2002 nutrition risk screening tool and the Global Leadership Initiative on Malnutrition(GLIM)for nutritional status assessment.According to the results,patients were divided into malnutrition and normal-nutrition groups.Multivariate Logistic regression was used to analyze the risk factors of malnutrition.Results:69.4%(75/108)of 108 patients were malnourished at admission.Univariate analysis showed that a long time interval from the end of radiotherapy,severe clinical symptoms,and long duration of gastrointestinal symptoms will lead to an increased risk of malnutrition[82.7%(62/75)vs 57.6%(19/33),χ^(2)=7.695,P=0.006;83.8%(62/74)vs 40.6%(13/32);χ^(2)=1570.500,P=0.004;89.3%(50/56)vs 60.9%(14/23),χ^(2)=8.559,P=0.003].Multivariate analysis confirmed that RTOG/EORTC≥GradeⅢ(P=0.003,OR=2.661,95%CI:1.400~5.055)and the duration of gastrointestinal symptoms≥1 month(P=0.003,OR=8.195,95%CI:2.025~33.161)are independent risk factors for malnutrition.Conclusion:Malnutrition is common in patients with chronic radiation enteropathy and is closely related to the duration and severity of gastrointestinal symptoms.Long-term nutrition guidance and follow-up plans should be established for patients to avoid prolonged exposure to nutritional risks and impaired nutritional status.