鼻咽癌放疗营养状况与放射性口腔黏膜炎的相关研究

Study on the relationship between nutritional status and radiation-induced oral mucositis in nasopharyngeal carcinoma during radiotherapy

目的评估鼻咽癌患者放疗前后营养状况与放射性口腔黏膜炎(ROM)的相关性,为临床提高放疗效果,降低放疗并发症,改善营养供应提供参考依据。方法前瞻性纳入2020年5月至2022年5月于江苏省人民医院首次确诊鼻咽癌患者共154例为研究对象,接受强调适形放疗(IMRT)或者放化疗,至少4周。比较放疗前和放疗4周后的营养指标,包括体重、体质指数(BMI)、血红蛋白、白蛋白和前白蛋白水平以及营养风险筛查2002(NRS 2002)评分,放疗后根据美国常见不良反应术语评定标准(CTCAE 5.0版)进行ROM严重程度分级,即无ROM组、轻中度组和重度组,比较不同ROM严重程度分级患者的营养指标和营养干预方式。结果154例患者放疗后体重、BMI、白蛋白和前白蛋白显著降低,而NRS 2002评分显著增加,差异有统计学意义(P<0.05)。放疗后无ROM组41例、轻中度组91例和重度组22例,三组放疗前各营养指标比较无明显差异(P>0.05),放疗后重度组体重、BMI、血红蛋白、白蛋白和前白蛋白显著低于轻中度组,各指标减少量显著高于轻中度组,NRS 2002评分以及增加量显著大于轻中度组(P<0.05);轻中度组与无ROM组之间也有显著差异(P<0.05)。重度组肠内营养显著多于轻中度组,肠外营养供给时间显著延长,营养供应总能量显著增加;轻中度组与无ROM组之间也有显著差异(P<0.05)。结论MRT的鼻咽癌患者ROM的发生与营养状况密切相关,可相互影响、相互作用;提高放疗技术,降低ROM发生风险是改善营养状况的重要方法。

Objective To evaluate the correlation between nutritional status and radiation-induced oral mucositis(ROM)in nasopharyngeal carcinoma(NPC)patients during radiotherapy,s0 as to provide a reference for clinical inprovement of radiotherapy ffect,reduction of radiotherapy conplication,any improvement of mutrition supply.Method A total of 154 patients with NPC diagnosis for the first time into our hospital from'May 2020 to May 2022 were enolled retrospectively.They received intensity modulated radiation therapy(IMRT)or chemoradiotherapy for at least 4 weeks.Compare the nutitional indicators before and 4 weeks after radiotherapy,including body weight,body mass index(BMI),hemoglobin,albumin and prealbumin levels,and the nutritional risk screening scome 2002(NRS 2002)score.After radiotherapy,grade of ROM severity according to the American Common Adverse Reaction Terminology Assessment Standard(CTCAE Version 5.0),that is,n0,mild to moderate and severe groups.Compare the nutritional indicators and nutritional intervention methods during the ROM groups.Result The body weight,BMI,albumin and prealbumin of 154 patients decresed signifcantly after radiothernapy,while the NRS 2002 score increased significantly(P<0.05).After radiotherapy,there were41 cases in the non ROM group,91 cases in the mild to moderate group and 22 cases in the severe group.There were no difences among the three groups of all the nutritional indicators before radiotherapy(P>0.05).After radiotherapy,the weight,BMI,bemoglobin,albumin and prealbunin in the severe group were signifcantly lower than those in the mild to moderate group,and the reduction of each indicator was significantly higher than that in the mild to moderate group,the NRS 2002 score and incresement were signifcantly higher than those in the mild to moderate group,too(P<0.05);there were also diferences between the mild to moderate group and the non ROM group(P<0.05).In severe group,enteral nutrition was significantly more than that in mild to moderate group,the time of parenteral nutrition supply was signifcantly longer,and the total enengy of nutrition supply was significantly higher;there were also differences between the mild to moderate group and the non ROM group,too(P<0.05).Conclusion ROM ocurence is closely related to nutritional status,which can influence and interect with each oher in NPC patients during IMRT,improwing radiotherapy technology and reducing the risk of ROM are important method to improve nutritional status.