规范化营养干预对食管癌放疗患者疗效及营养状况的影响

Effect of standardized nutritional therapy on efficacy and nutritional status in esophageal cancer patients undergoing radiation therapy

目的探讨规范化营养干预对食管癌放疗患者治疗疗效及营养状况的影响。方法采用回顾性分析方法,收集2019年12月至2021年12月宁波市医疗中心李惠利医院收治的100例食管癌放疗患者,以2020年8月前未开展规范化营养治疗的自主饮食患者为对照组,2020年8月后行规范化营养干预的患者作为观察组,每组50例。比较两组患者放疗前后各项营养指标、放疗不良反应发生率及治疗疗效,采用二元logistic回归分析影响患者营养治疗疗效的因素。结果观察组放疗前各类营养指标均差于对照组(均P<0.05),放疗结束后白蛋白、总蛋白、男性Hb等均优于对照组(均P<0.05),放疗结束后3个月两组营养指标比较,差异均无统计学意义(均P>0.05)。营养风险筛查2002量表(NRS 2002)动态评估显示,放疗后和放疗结束后3个月,观察组营养状态均优于对照组(均P<0.01)。进一步分析发现<65岁及联合治疗(包括放疗联合化疗、放疗联合免疫治疗或3者联合)的人群在规范化营养干预中受益最佳。结论对于食管癌放疗患者,规范化营养干预有利于改善基线状态差的患者治疗后的营养状况,尤其<65岁及联合治疗的患者受益最佳。

Objective To investigate the effect of standardized nutritional therapy on the therapeutic outcome and nutritional condition of esophageal cancer patients undergoing radiation therapy.Methods One hundred patients with esophageal cancer who underwent radiation therapy at the Ningbo Medical Center Lihuili Hospital between December 2019 and December 2021 were enrolled,including 50 cases received standardized nutritional intervention(study group)and 50 cases received conventional diet(control group).The nutritional indicators before and after radiotherapy,the incidence of adverse radiation reactions,and treatment outcomes were compared between two groups.The factors influencing the efficacy of nutritional therapy were analyzed with binary logistic regression.Results Before radiation therapy,all nutritional indices of the study group were inferior to those of the control group(all P<0.05).However,after intervention,most nutritional indices,including albumin,total protein,Hb in males of the study group were superior to those of the control group(all P<0.05).There were no significant differences in the nutritional indices between the two groups three months after radiotherapy(all P>0.01).However,in the nutritional risk screening 2002(NRS 2002)dynamic assessment,the nutritional status of the study group was better than that of the control group,either immediately after radiotherapy or three months after radiotherapy(all P<0.01).Further analysis showed that individuals under 65 years of age and those undergoing combined therapy(radiation therapy with chemotherapy and/or immunotherapy)gained the most benefit from standardized nutritional intervention.Conclusion Standardized nutritional therapy is effective for improving the post-radiotherapy nutritional status,particularly in esophageal cancer patients with poor baseline conditions who are under 65 years of age or are undergoing combined therapy.