放疗期间营养状况与放射性口腔黏膜炎相关性的探索

Study on the Correlation Between Nutritional Status and Radiation Oral Mucositis During Radiotherapy

目的通过横断面研究探索头颈部肿瘤患者在放疗期营养状况及与不良反应的相关性。筛选并纳入更全面的营养评估与检测指标,构建多维度的精准营养评价体系,有望探索有效营养预测生物标志物或模型。方法开展横断面研究,纳入苏州大学附属第一医院放疗科及常熟市第二人民医院肿瘤放疗科2020年1月—2022年3月收治的92例头颈部肿瘤(鼻咽癌、口咽癌、口腔癌、喉癌等)患者,收集NRS2002评分、体重(BW)、体质指数(BMI)、血红蛋白(Hb)、白蛋白(Alb)、放射性口腔黏膜炎分级、疼痛评分等各项指标。结果放疗开始及放疗进行一半时,营养风险发生率低,而放疗结束时营养风险发生率高;放疗结束时BW、BMI、Hb等指标水平均低于放疗半程,且低于放疗前;放疗结束时放射性口腔黏膜炎分级、NRS评分均高于放疗半程且高于放疗前,差异均有统计学意义(P<0.05)。BW、BMI、Hb、Alb与放射性口腔黏膜炎分级、NRS评分呈负相关性(P<0.05)。结论头颈部肿瘤患者在放疗过程中,由于发生口腔黏膜炎进食疼痛的原因,营养情况明显恶化,从而减慢黏膜愈合程度,通过多种手段及指标建立营养预测模型,精准动态掌握病人的营养情况。

Objective To explore the nutritional status and its correlation with adverse reactions in patients with head and neck tumors during radiotherapy by cross-sectional research.Screening and incorporating more comprehensive nutrition assessment and detection indicators,and building a multi-dimensional precision nutrition evaluation system,it is expected to explore effective nutrition prediction biomarkers or models.Methods A cross-sectional study was conducted including 92 patients with head and neck tumors(nasopharyngeal carcinoma,oropharyngeal carcinoma,oral cancer,laryngeal cancer,etc.)treated in the Department of Radiotherapy of the First Affiliated Hospital of Soochow University and the Department of Tumor Radiotherapy of Changshu Second People's Hospital from January 2020 to March 2022.Various indicators were collected before radiotherapy(T1),halfway through radiotherapy(T2),and at the end of radiotherapy(T3),including NRS2002 score,body weight(BW),body mass index(BMI),hemoglobin(Hb),albumin(Alb),grading of radioactive oral mucositis,pain score,etc.Results The incidence of nutritional risk was low at the beginning and halfway through radiotherapy,but high at the end of radiotherapy.At the end of radiotherapy,the levels of BW,BMI,Hb and other indicators were lower than halfway through radiotherapy and lower than before radiotherapy.At the end of radiotherapy,the grading of radioactive oral mucositis and NRS score were higher than halfway through radiotherapy and higher than before radiotherapy.The differences were statistically significant(P<0.05).BW,BMI,Hb,Alb were negatively correlated with grading of radioactive oral mucositis and NRS score(P<0.05).Conclusion During radiotherapy in patients with head and neck tumors,due to the occurrence of oral mucositis and pain when eating,their nutritional status deteriorates significantly,which slows down the healing of mucous membranes.By establishing a nutritional prediction model through various means and indicators,the patient's nutritional status can be accurately grasped dynamically.