老年口腔癌患者围术期营养不良的影响因素及免疫营养支持的效果分析

Analysis of influencing factors of perioperative malnutrition in elderly patients with oral cancer and effects of immunonutrition support

目的探讨老年口腔癌患者围术期营养状况及免疫营养支持的效果。方法选取2021年1月—2023年8月在廊坊市人民医院行口腔癌根治术的老年口腔癌患者166例作为研究对象。采用患者主观整体营养评估(PG-SGA)方法评估患者围术期营养状态,并据此将患者分为营养不良风险组和营养正常组,比较2组临床资料,采用Logistic回归方法分析老年口腔癌患者围术期营养不良的影响因素。营养不良风险组患者在术后给予免疫营养支持治疗,统计分析患者治疗前、治疗2周后营养指标值[血清白蛋白(ALB)、总蛋白(TP)、转铁蛋白(TRF)、前白蛋白(PAB)、血红蛋白(Hb)、维生素B12、叶酸水平]和免疫指标值[免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)水平]。结果本研究纳入的166例老年口腔癌患者中131例患者有营养不良风险,发生率为78.92%;二元Logistic分析结果显示,吸烟、临床分期Ⅲ~Ⅳ期、术前合并症均为影响老年口腔癌患者围术期营养不良的独立危险因素(P<0.05);与治疗前比较,治疗2周后营养不良风险组BMI、ALB、TP、TRF、PAB、Hb、维生素B12、叶酸水平均升高(P<0.05),且IgG、IgA、IgM水平均升高(P<0.05);2组不良反应总发生率差异无统计学意义(P>0.05)。结论老年口腔癌患者营养不良的危险因素可能主要为吸烟、临床分期Ⅲ~Ⅳ期、术前合并症,而免疫营养支持可能有效改善老年口腔癌伴营养不良患者营养状态和免疫功能。

Objective To explore the influence factors of perioperative malnutrition in elderly patients with oral cancer and the effects of immunonutrition support.Methods A total of 166 elderly patients with oral cancer who underwent radical operation in People's Hospital of Langfang City from January 2021 to August 2023 were enrolled as the study subjects.The perioperative nutritional status of patients was assessed by the Patient Generated Subjective Global Assessment(PG-SGA),and they were divided into malnutrition risk group and normal nutrition group.The clinical data of the two groups were compared.Logistic regression method was used to analyze the influencing factors of perioperative malnutrition in elderly patients with oral cancer.Patients in the malnutrition risk group received immunonutrition support therapy after surgery.The levels of nutritional indexes[serum albumin(ALB),total protein(TP),transferrin(TRF),prealbumin(PAB),hemoglobin(Hb),vitamin B12,folate]and immune indexes[immunoglobulin G(IgG),immunoglobulin A(IgA),immunoglobulin M(IgM)]in the two groups were statistically analyzed before surgery and at 2 weeks after surgery.Results Among 166 elderly patients with oral cancer included in this study,131 were at risk of malnutrition,with an incidence of 78.92%.Binary Logistic analysis showed that smoking,clinical stage Ⅲ~Ⅳ and preoperative comorbidities were independent risk factors for perioperative malnutrition in elderly patients with oral cancer(P<0.05).The levels of BMI,ALB,TP,TRF,PAB,Hb,vitamin B12,and folate in the malnutrition risk group after 2 weeks of treatment were higher than those of the same group before treatment(P<0.05).The levels of IgG,IgA and IgM in the malnutrition risk group after 2 weeks of treatment were also higher than those of the same group before treatment(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The risk factors for malnutrition in elderly oral cancer patients may mainly include smoking,clinical stages Ⅲ~Ⅳ,and preoperative complications.Immunonutrition support can effectively improve nutritional status and immune function in elderly patients with oral cancer and malnutrition.