能量摄入对头颈癌放化疗患者营养状况和生活质量的影响  

Energy intake on nutritional status and quality of life in head and neck cancer patients receiving radiotherapy and chemotherapy

作　　者：龚丽青[1] 王艳莉[1] 孙艳[1] 辛晓伟[1] 姜蕾蕾[1] 岳海振[1] 方玉[1] GONG Li-qing;WANG Yan-li;SUN Yan;XIN Xiao-wei;JIANG Lei-lei;YUE Hai-zhen;FANG Yu(Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education）, Department of Nutrition, Peking University Cancer Hospital ＆ Institute, Beijing 100142, China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所营养科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《肿瘤代谢与营养电子杂志》2018年第1期48-52,共5页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：北京市自然科学基金(1174016);首都卫生发展科研专项(首发2018-4-1027)

摘　　要：目的探讨能量摄入量对头颈癌患者放化疗期间营养状况、体成分及生活质量的影响。方法选取符合入选标准的头颈癌患者90例,分别在放化疗前和放疗结束2个时段对患者进行调查,调查内容包括:营养评估、膳食调查、体成分测量以及生活质量四个部分。临床营养师通过24小时膳食调查获得患者的能量摄入量,包括膳食能量摄入以及ONS,同时采用Harris-Benedict公式获得患者的能量需要量,从而计算患者的能量摄入量占需要量的比例,能量摄入占比<70%为A组,能量摄入占比≥70%为B组。结果两组患者的基线资料,包括年龄、性别、BMI、治疗前的营养状况、临床分期、诊断、放疗剂量以及治疗方式等方面差异均无统计学意义(P>0.05),两组具有可比性。放疗结束后,A组患者营养不良发生率明显高于B组,A组患者营养不良发生率为100%,B组为84.09%,差异具有统计学意义(P<0.05);24小时膳食调查发现,A组患者每天通过膳食和ONS摄入的能量分别为864kcal和214kcal,明显低于B组,差异具有统计学意义(P<0.05)。使用放疗前后体成分的变化值来表示能量摄入量对体成分的影响,发现A组患者BMI、体重、肌肉、蛋白质、骨骼肌和体脂百分比的变化均大于B组,两组除了蛋白质和骨骼肌的变化没有统计学意义外,其他指标差异均具有统计学意义(P<0.05);放疗前,两组患者生活质量评分没有明显的统计学差异;放疗结束后,A组患者功能评分均比B组偏低,而症状评分都偏高;在生活质量、认知功能、疼痛、疲倦、食欲丧失等方面两组间差异都具有统计学意义。结论头颈癌患者经放化疗后,营养状况、体成分及生活质量恶化,而在治疗前和治疗过程中保持能量摄入量占比≥70%可以防止进一步恶化。Objective To evaluate the effect of different levels of energy intake on nutritional status and quality of life in patients with head and neck cancer during radiochemotherapy. Methods Four items including nutritional assessment, dietary survey, measuring body composition and quality of life were employed to investigate 90 patients with head and neck cancer which meet the inclusion criteria in two periods, including the stage before radiochemotherapy and the end of radiotherapy. Dietary intake was estimated by a 24h dietary recall conducted by the oncology dietitian each time, including energy from food and oral nutritional supplements. Energy requirements were estimated by using Harris-Benedict equation, then the energy ratio was calculated. The proportion of energy intake〈70% was group A, and the proportion of energy intake≥70% was group B. Results There were no significant differences in clinical data, including age, gender, BMI, nutritional status, clinical stage, dignosis, radiological dose and treatment method between group A and group B （P〉0.05）, so the two groups were comparable. At the end of radiotherapy, the incidence of malnutrition in group A was signifcantly higher than group B, the incidence of malnutrition in group A and group B were 100% and 84.09%, respectively. According to 24h dietary recall, the energy intake from food and ONS in group A were 864kcal and 214kcal, respectively, which were signifcantly lower than group B （P〈0.05）. The infuences on body compositions by energy intake were expressed by the changes before and after radiotherapy. The results showed that the changes of BMI, weight, muscle mass, protein, skeletal mass and percentage of body fat in group A were greater than in group B. All the changes beween two group had signifcant differences （P 〈0.05）, besides the changes of protein and skeletal mass. Before radiotherapy, there were no signifcant differences in life quality scores between two groups. However, at the end of the radiotherapy, the functional sco

关 键 词：头颈癌 营养评估 人体成分测量 生活质量 膳食调查 

分 类 号：R459.3[医药卫生—治疗学] R739.91[医药卫生—临床医学]