转移性肝癌患者营养状况及影响因素分析  

Nutritional status and influencing factors for patients with metastatic liver cancer

作　　者：李晨琪 张克诚 谢祁羽 张丞林 刘阳 葛瑞良 LI Chenqi;ZHANG Kecheng;XIE Qiyu;ZHANG Chenglin;LIU Yang;GE Ruiliang(Department of Nutrition,the Third Affiliated Hospital of Naval Medical University,Shanghai 200438,China;Department of Biliary Tract Surgery(Ⅳ),the Third Affiliated Hospital of Naval Medical University,Shanghai 200438,China;School of Basic Medicine,Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第三附属医院营养科,上海200438 [2]海军军医大学第三附属医院胆道四科,上海200438 [3]海军军医大学基础医学院,上海200433

出　　处：《肝胆胰外科杂志》2025年第2期81-85,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：国家自然科学基金(52371146);上海市公共卫生研究专项青年项目(2024GKQ26);上海市“科技创新行动计划”启明星扬帆专项(24YF2758300);嘉定区自然科学研究课题(JDKW-2024-0013)。

摘　　要：目的探究转移性肝癌患者营养状况及影响因素,并分析营养相关生化指标,为采取个体化的营养支持提供理论依据。方法前瞻性选取2023年11月至2024年2月就诊于海军军医大学第三附属医院的99例转移性肝癌患者,采用营养风险筛查2002(NRS 2002)量表进行调查,采用Logistic回归分析发生营养风险的相关因素。结果99例转移性肝癌患者的营养风险发生率为35.4%。单因素分析结果显示,转移性肝癌患者的年龄、原发肿瘤类型、握力、身体质量指数(BMI)以及血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、天门冬氨酸氨基转移(AST)、血红蛋白(HGB)、视黄醇结合蛋白(RBP)与营养风险存在显著关联(P<0.05)。多因素Logistic回归分析显示,年龄越大(OR=0.175,95%CI 0.018-1.712,P=0.034)、握力越小(OR=2.985,95%CI 1.170-8.564,P=0.040)、BMI越低(OR=3.337,95%CI 3.123-6.922,P=0.021)、血清ALB越低(OR=2.828,95%CI 0.209-38.255,P=0.038)、血清PA越低(OR=1.911,95%CI2.917-14.081,P=0.008)的患者营养风险越高。结论医护人员应该对转移性肝癌患者进行营养风险筛查,同时重点关注低握力的老年患者,并检测患者BMI及血清ALB、PA的水平,对其进行营养宣教,认识营养风险的危害,提高自身健康管理的认识,并为患者制定实施个体化的营养支持。Objective To investigate the nutritional status and influencing factors of patients with metastatic liver cancer,to analyze the nutrition-related biochemical indicators,in order to provide a theoretical basis for individualized nutritional support.Methods A total of 99 patients with metastatic liver cancer,who were admitted to the Third Affiliated Hospital of Naval Medical University from Nov.2023 to Feb.2024,were prospectively enrolled in this study.The Nutritional Risk Screening 2002(NRS 2002)was used to conduct the survey,and Logistic regression analysis was performed to identify factors associated with the nutritional risk.Results The incidence of the nutritional risk in 99 patients with metastatic liver cancer was 35.4%.Univariate analysis revealed significant associations between the nutritional risk and the patients'age,primary tumor type,grip strength,BMI,as well as blood levels of TP,ALB,PA,AST,HGB and RBP(P<0.05).Multivariate Logistic regression analysis indicated that older age(OR=0.175,95%CI 0.018 to 1.712,P=0.034),lower grip strength(OR=2.985,95%CI 1.170 to 8.564,P=0.040),lower BMI(OR=3.337,95%CI 3.123 to 6.922,P=0.021),lower blood ALB(OR=2.828,95%CI 0.209 to 38.255,P=0.038)and lower blood PA levels(OR=1.911,95%CI 2.917to 14.081,P=0.008)were associated with a higher risk of malnutrition.Conclusion Medical staffs should screen patients with metastatic liver cancer for the nutritional risk,focusing on elderly patients with low grip strength.It is also important to monitor patients'BMI,serum ALB and PA levels,provide nutritional education,raise awareness of the hazards of the nutritional risk,improve self-health management awareness,as well as develop and implement individualized nutritional support for patients.

关 键 词：转移性肝癌 营养风险筛查2002 营养相关指标 握力 身体质量指数 白蛋白 前白蛋白 

分 类 号：R735.7[医药卫生—肿瘤] R459.3[医药卫生—临床医学]