食管癌根治性放疗患者营养风险筛查的临床意义  

Clinical significance of nutritional risk screening in patients with esophageal cancer undergoing radical radiotherapy

作　　者：刘燕[1] 吕茵[1] 穆克代斯·伊力亚斯[1] 卢喜[1] 曾敏[1] LIU Yan;LV Yin;Mukedaisi Yiliyasi;LU Xi;ZENG Min(The Affiliated Tumor Hospital of Xinjiang Medical University,Department of Thoracic and Abdominal Radiology,Urumqi 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院胸腹放射治疗科,乌鲁木齐830011

出　　处：《新疆医科大学学报》2022年第8期829-834,共6页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金(2021D01C395)。

摘　　要：目的 了解局部晚期食管癌患者行根治性放疗期间的营养状况,为临床进行个体化营养支持提供参考依据。方法 回顾性分析2015年1月-2018年10月新疆医科大学附属肿瘤医院收治的局部晚期食管癌患者166例,联合运用营养风险筛查2002(NRS 2002)评分、体格测量、相关血液学指标检测和不良反应情况,全面评估患者营养状况;并采用Kaplan-Meier法分析不同营养状况患者3年生存率。结果 166例局部晚期食管癌患者放疗期间均出现体重下降,体重减轻≥5%者占33.7%;血红蛋白(Hb)、总蛋白(TP)、白蛋白(ALB)在放疗期间均呈进行性下降趋势,放疗结束时较放疗前均呈不同程度降低(P<0.05);放疗结束时NRS2002评分较入院时呈逐渐升高趋势,营养不良比例增加,并且放疗期间均出现不同程度的急性不良反应。Spearman秩和检验结果显示体重、BMI、Hb、TP和ALB与NRS2002评分均呈负相关(P<0.05),相关不良反应与NRS2002评分无相关性(P<0.05)。NRS 2002评分<3分的患者3年生存率优于NRS 2002评分≥3分的患者(入院时55.6%vs 30.9%,放疗结束时55.9%vs 36.7%,P<0.05)。结论 局部晚期食管患者放疗期间,体重、BMI、Hb、TB及ALB的下降提示患者存在较高的营养风险,NRS 2002筛查有营养风险的患者预后较差。Objective To understand the nutritional status of the patients with esophageal cancer during radical radiotherapy and to provide reference for clinical individualized nutritional support.Methods 166 patients with locally advanced esophageal cancer treated in the hospital from January 2015 to October 2018 were retrospectively analyzed.Nutritional risk screening 2002(NRS 2002),physical measurement,related hematological indicators and CTCAE 5.0were used to evaluate adverse reactions,and nutritional status of the patients were comprehensively evaluated;Kaplan Meier method was used to analyze 3-year overall survival(OS) of the patients with different nutritional status.Results166 patients with esophageal cancer had weight loss during the treatment,and 33.7% of the patients had weight loss ≥5%;Hb,TP and ALB hematological indexes showed a progressive downward trend during the treatment period,and the proportion below the normal value at the end of radiotherapy was increased for comparing with that at admission;At the end of radiotherapy,nrs2002 score gradually was increased for comparing with that at admission,and proportion of malnutrition was increased,and acute adverse reactions of varying degrees occurred during the treatment.Spearman rank sum test showed that weight,BMI,Hb,TP and ALB were negatively correlated with nrs2002 score(P<0.05),and the related adverse reactions were not correlated with nrs2002 score(P>0.05).3-year OS rate of the patients with NRS 2002 score < 3 were better than that of the patients with NRS 2002 score ≥ 3(55.6% vs 30.9% at admission,55.9% vs 36.7% at the end of radiotherapy,P<0.05).Conclusion The decreasing of body weight,BMI,Hb,TB and ALB in patients with locally advanced esophagus during the radiotherapy suggests that the patients have high nutritional risk.The prognosis of the patients with nutritional risk screened by NRs 2002 is poor.

关 键 词：食管癌 放疗 营养风险筛查 临床意义 

分 类 号：R735.1[医药卫生—肿瘤]