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鼻咽癌放化疗后营养不良的危险因素与应对策略分析

Risk Factors and Coping Strategies for Malnutrition after Radiotherapy and Chemotherapy in Nasopharyngeal Carcinoma
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摘要 目的分析鼻咽癌放化疗后营养不良的危险因素与应对策略。方法回顾性分析本院2021年1月至2023年1月间采用同步放化疗治疗的鼻咽癌患者资料,将其中治疗后营养不良的31例患者纳入营养不良组,根据营养不良组患者的性别、年龄,按1:2比例采用倾向匹配法从未发生营养不良的患者筛选62例患者纳入营养良好组。对比两组患者的一般资料:性别、年龄、体重指标(BMI),临床资料:TNM分期、放化疗后指标:味觉障碍、PSQI、肠内营养支持治疗、KPS、前白蛋白、白蛋白、血红蛋白,其中具有统计学差异的项目为鼻咽癌放化疗后营养不良的相关因素;将全部相关因素代入Logistic模型分析,明确各相关因素与营养不良关系;以受试者工作特征(ROC)曲线分析各危险因素对于放化疗后营养不良的评估价值,计算效能指标:临界(cutoff)值、敏感度、特异性,据此探讨应对策略。结果肠内营养支持治疗、前白蛋白、白蛋白、血红蛋白为鼻咽癌同步放化疗后营养不良发生的相关因素(P<0.05);无肠内营养支持治疗、前白蛋白偏低、白蛋白偏低、血红蛋白偏低为鼻咽癌同步放化疗后营养不良发生的危险因素(OR≥1,P<0.05);无肠内营养支持治疗对同步放化疗后营养不良具有中等评估价值(0.7<AUC≤0.9,P<0.05);白蛋白≤41.705g/L对同步放化疗后营养不良具有中等评估价值(0.7<AUC≤0.9,P<0.05);前白蛋白≤0.215g/L、血红蛋白≤119.435g/L对同步放化疗后营养不良具有较低评估价值(0.5≤AUC≤0.7,P<0.05)。结论鼻咽癌放化疗后营养不良的危险因素包括:无肠内营养支持治疗、前白蛋白、白蛋白、血红蛋白偏低,根据患者具备的危险给予相应干预,能够有效改善患者放化疗后的营养状态。 Objective To analyze the risk factors and coping strategies for malnutrition after radiotherapy and chemotherapy in nasopharyngeal carcinoma.Methods A retrospective analysis was conducted on the data of nasopharyngeal carcinoma patients treated with synchronous radiotherapy and chemotherapy in our hospital from January 2021 to January 2023.Among them,31 patients with malnutrition after treatment were included in the malnutrition group.Based on the gender and age of the patients in the malnutrition group,62 patients who had never experienced malnutrition were selected and included in the well nourished group using the propensity matching method in a 1:2 ratio.Compare the general information of two groups of patients:gender,age,body mass index(BMI),clinical data:TNM staging,post radiotherapy and chemotherapy indicators:taste disorders,PSQI,enteral nutrition support treatment,KPS,prealbumin,albumin,hemoglobin,among which the items with statistical differences are related factors of malnutrition after radiotherapy and chemotherapy for nasopharyngeal carcinoma;Substitute all relevant factors into the logistic model analysis to clarify the relationship between each relevant factor and malnutrition;Analyze the evaluation value of various risk factors for malnutrition after radiotherapy and chemotherapy using the receiver operating characteristic(ROC)curve,calculate efficacy indicators such as cut-off value,sensitivity,and specificity,and explore coping strategies accordingly.Results Enteral nutrition support therapy,prealbumin,albumin,and hemoglobin were related factors for malnutrition after concurrent radiotherapy and chemotherapy in nasopharyngeal carcinoma(P<0.05);Lack of enteral nutrition support treatment,low prealbumin,low albumin,and low hemoglobin are risk factors for malnutrition after concurrent radiotherapy and chemotherapy for nasopharyngeal carcinoma(OR≥1,P<0.05);The treatment without enteral nutrition support has moderate evaluation value for malnutrition after synchronous radiotherapy and chemotherapy(0.7<AUC≤0.9,P<0.05);Albumin≤41.705g/L has moderate evaluation value for malnutrition after synchronous radiotherapy and chemotherapy(0.7<AUC≤0.9,P<0.05);Pre albumin≤0.215g/L and hemoglobin≤119.435g/L have lower evaluation value for malnutrition after synchronous radiotherapy and chemotherapy(0.5≤AUC≤0.7,P<0.05).Conclusion The risk factors for malnutrition after radiotherapy and chemotherapy for nasopharyngeal carcinoma include:lack of enteral nutrition support treatment,low levels of prealbumin,albumin,and hemoglobin.Corresponding interventions based on the patient's risk can effectively improve the nutritional status of patients after radiotherapy and chemotherapy.
作者 王莉 WANG Li(The Second Hospital of Tianjin Medical University,Tianjin 300211,China)
出处 《罕少疾病杂志》 2024年第10期24-26,共3页 Journal of Rare and Uncommon Diseases
关键词 鼻咽癌 同步放化疗 危险因素 应对策略 Nasopharyngeal Carcinoma Synchronous Radiotherapy and Chemotherapy Risk Factors Coping Strategies
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