肺癌患者营养状态与化疗不良反应及癌因性疲乏的相关性研究

Relationship between nutritional status and chemotherapy incduced adverse reactions and cancer related fatigue in patients with lung cancer

目的 探讨肺癌患者营养状态与化疗不良反应及癌因性疲乏的相关性。方法 选取2018年10月至2020年12月间上海中医药大学附属曙光医院收治的84例肺癌化疗住院患者,化疗前采用预后营养指数(PNI)评估营养状态,依据PNI中位数分为营养较差组(PNI<49)和营养较好组(PNI≥49),每组42例。化疗2个周期后评定化疗效果,比较两组患者化疗不良反应发生率和癌症疲乏量表(CFS)评分,采用Pearson法分析PNI与CFS评分的相关性,采用Logistic回归分析化疗不良反应发生的影响因素。结果 营养较差组患者有效缓解27例(64.3%),营养较好组为30例(71.4%),两组比较,差异无统计学意义(P>0.05)。营养较好组患者Ⅲ~IV级不良反应率和化疗不良反应发生率均低于营养较差组,差异均有统计学意义(均P<0.05)。营养较好组患者躯体疲乏评分和CFS总分均低于营养较差组,差异均有统计学意义(均P<0.05);两组患者情感疲乏和认知疲乏评分比较,差异无统计学意义(P>0.05)。相关性分析显示,肺癌患者化疗前PNI与化疗后躯体疲乏评分、CFS总分均呈负相关(均P<0.05)。将28例出现化疗不良反应患者记为事件组,56例未出现化疗不良反应患者记为无事件组,单因素资料比较显示,事件组化疗前PNI(45.69±11.35)低于无事件组(52.63±7.37),年龄(66.25±6.37)岁高于无事件组(62.62±7.18)岁,差异均有统计学意义(均P<0.05);性别构成、肺癌类型(NSCLC/SCLC)和临床分期(Ⅲ~IV期)比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,年龄和化疗前PNI均是肺癌患者发生化疗不良反应的影响因素(均P<0.05)。结论 肺癌患者PNI与化疗不良反应及癌因性疲乏程度紧密相关,临床护理中应重视营养风险筛查,并制定干预措施,以改善营养状态。

Objective To investigate the correlation between nutritional status and chemotherapy induced adverse reactions and cancer related fatigue in patients with lung cancer. Methods Eighty-four patients with lung cancer treated at Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were selected from October 2018 to December 2020. The nutritional status was evaluated by prognostic nutritional index(PNI) before chemotherapy. According to the median PNI, they were divided into a poor nutrition group(PNI<49) and a good nutrition group(PNI≥49) with 42 patients in each group. The efficacy of chemotherapy was evaluated after 2 cycles of chemotherapy. The incidence of adverse reactions and the score of cancer fatigue scale(CFS) were compared between the two groups. Pearson method was used to analyze the correlation between PNI and CFS score. Logistic regression was used to analyze the factors influencing chemotherapy induced adverse reactions. Results Effective remission was achieved in 27 patients(64.3%) in the poor nutrition group and 30 patients(71.4%) in the good nutrition group(P>0.05). The grade Ⅲ to IV adverse reaction rate and chemotherapy induced adverse reaction rate were lower in the good nutrition group than in the poor nutrition group(all P<0.05). Physical fatigue and overall CFS scores were lower in the good nutrition group than in the poor nutrition group(P<0.05). There was no significant difference in psychological fatigue and cognitive fatigue scores between the two groups(P>0.05). PNI before chemotherapy was negatively associated with physical fatigue and overall CFS scores(all P<0.05). When 28 patients who had chemotherapy induced adverse reactions were included in an event group and rest 56 who did not have chemotherapy induced adverse reactions were included in a nonevent group, univariate analysis showed that PNI before chemotherapy was lower in the event group(45.69±11.35) than in the nonevent group(52.63±7.37) and age were higher in the event group(66.25±6.37) years than in the nonevent group(62.62±7.18) years in the nonevent group(all P<0.05). There was no significant difference in the above variables among patients of different gender, lung cancer type(NSCLC/SCLC) and cancer stage(Ⅲ~IV)(P>0.05). Multivariate analysis showed that age and PNI before chemotherapy were factors influencing chemotherapy induced adverse reactions in lung cancer patients(all P<0.05). Conclusion PNI is closely associated with chemotherapy induced adverse reactions and cancer related fatigue in lung cancer patients. Clinical nursing should focus on nutritional risk screening, and develop intervention measures to improve nutritional status.