鼻咽癌患者放疗前预后营养指数与急性口腔黏膜炎严重程度的相关性分析

Correlation analysis between prognostic nutritional index before radiotherapy and severity of acute oral mucositis in patients with nasopharyngeal carcinoma

目的分析鼻咽癌患者放疗前预后营养指数(prognostic nutritional index,PNI)与急性口腔黏膜炎严重程度的相关性。方法本研究为回顾性研究,选取2019年1月至2021年12月武汉市第三医院收治的88例接受放疗的初治鼻咽癌患者为研究对象,采用放疗肿瘤协作组制定的黏膜急性放射损伤分级标准评估患者放疗结束时口腔黏膜炎的严重程度,Ⅰ级和Ⅱ级为轻度口腔黏膜炎并归为轻度组,Ⅲ级和Ⅳ级为重度口腔黏膜炎并归为重度组。比较两组患者的临床特征和放疗前PNI,采用多因素Logistic回归分析探讨放疗前PNI与放疗后口腔黏膜炎严重程度的相关性。结果全部患者放疗后均出现不同程度的口腔黏膜炎,发生率达100%,包括Ⅰ级36例(40.9%),Ⅱ级29例(33.0%),Ⅲ级17例(19.3%),Ⅳ级6例(6.8%),即重度口腔黏膜炎的发生率为26.1%(23/88)。重度组患者年龄、V_(15)/V_(20)/V_(25)/V_(30)/V_(35)等口腔黏膜的剂量体积参数均显著大于轻度组(均P<0.05),初中及以下文化程度、有吸烟史、有糖尿病病史、口腔pH值≤6.5、口腔黏膜照射剂量≥32 Gy、同步化疗、放疗前PNI<45的患者占比均显著高于轻度组(均P<0.05)。多因素Logistic回归分析结果表明,有吸烟史、口腔pH值≤6.5、放疗前PNI<45均为鼻咽癌患者放疗后发生重度口腔黏膜炎的独立危险因素(均P<0.05)。结论鼻咽癌患者放疗前PNI<45是放疗后重度口腔黏膜炎发生的独立危险因素,营养不良与口腔黏膜炎的严重程度有关。

Objective To analyze the correlation between prognostic nutritional index (PNI) before radiotherapy and severity of acute oral mucositis in patients with nasopharyngeal carcinoma.Method This study is a retrospective study,and 88 cases of patients with nasopharyngeal carcinoma who received radiotherapy in Wuhan Third Hospital were enrolled for the research.The severity of oral mucositis at the end of radiotherapy was evaluated according to the grading criteria of acute radiation injury of mucosa established by Radiation Therapy Oncology Group,and cases with grade Ⅰ and Ⅱ were regarded as mild oral mucositis and classified as mild group,while patients with grade Ⅲ and Ⅳ were regarded as severe oral mucositis and classified as severe group.The clinical characteristics and PNI before radiotherapy were compared between the two groups,and the correlation between PNI before radiotherapy and the severity of oral mucositis after radiotherapy was discussed by multifactor Logistic regression.Result All patients suffered from different degrees of oral mucositis after radiotherapy,and the incidence rate was 100%,including 36 cases (40.9%) of grade Ⅰ,29 cases (33.0%) of grade Ⅱ,17 cases (19.3%) of grade Ⅲ,and 6 cases (6.8%) of grade Ⅳ,the incidence rate of severe oral mucositis was 26.1% (23/88).The age,dose volume parameters of oral mucosa such as V_(15)/V_(20)/V_(25)/V_(30)/V_(35)in severe group were significantly higher than those in mild group (all P<0.05),the proportion of patients with junior high school education,smoking history,diabetes mellitus history,oral pH≤6.5,oral mucosa irradiation dose≥32 Gy,concurrent chemotherapy and PNI<45 before radiotherapy were significantly higher than those in mild group (all P<0.05).Multivariate Logistic regression analysis showed that smoking history,oral pH≤6.5 and PNI<45 before radiotherapy were the independent risk factors for severe oral mucositis in patients with nasopharyngeal carcinoma after radiotherapy (all P<0.05).Conclusion PNI<45 before radiotherapy is an independent risk factor for severe oral mucositis after radiotherapy in patients with nasopharyngeal carcinoma.Malnutrition is related to the severity of oral mucositis.