晚期肿瘤患者的营养影响症状分布规律及中医证型探索  

Exploration of the Distribution Patterns of Nutrition Impact Symptoms and Traditional Chinese Medicine Syndromes in Advanced Cancer Patients

作　　者：谢虹亭 安宸 孙权 宗铭桐 薛鹏 席玲泽 朱世杰[1] XIE Hongting;AN Chen;SUN Quan;ZONG Mingtong;XUE Peng;XI Lingze;ZHU Shijie(Department of Oncology,Wangjing Hospital of China Academy of Chinese Medicine Sciences,Beijing 100102,China;Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]中国中医科学院望京医院肿瘤科,北京100102 [2]北京中医药大学研究生院,北京100029

出　　处：《中医肿瘤学杂志》2025年第2期23-29,共7页Journal of Oncology in Chinese Medicine

基　　金：中国中医科学院科技创新工程重点协同攻关项目(编号:CI2022C002-04);中国中医科学院科技创新工程创新团队(编号:CI2021B009)。

摘　　要：目的研究晚期肿瘤营养不良患者的营养影响症状(nutrition impact symptom,NIS)分布规律及其中医证型探索,分析NIS分级与肿瘤营养不良的相关性。方法采用一般资料调查问卷、患者参与的主观全面评定(patient-generated subjective global assessment,PG-SGA)量表、NIS分级评价和免疫炎症指标进行调查。分析晚期肿瘤营养不良患者的临床特征、NIS分布规律、中医证型分布以及NIS分级与营养不良的相关性。结果127例晚期肿瘤患者中,中度营养不良19例,重度营养不良108例。晚期肿瘤中重度营养不良患者NIS发生率达98.4%,中度营养不良患者NIS均数为2.7个,重度营养不良患者NIS均数为5.8个。91例患者中,脾胃气虚证17例、脾胃阴虚证41例、气阴两虚证33例。PG-SGA得分和系统免疫炎症指数(systemic immune inflammation index,SII)在3种证型间差异具有统计学意义(P<0.05)。PG-SGA评分与口干、味觉减退、食欲不振、恶心、呕吐、便秘、腹胀/腹痛和乏力分级呈明显正相关(P<0.05),预后营养指数(prognostic nutritional index,PNI)、SII、白蛋白(albumin,ALB)、前白蛋白(prealbumin,PAB)与口干、食欲不振、恶心、便秘分级呈明显相关(P<0.05)。结论晚期肿瘤营养不良患者可能以脾胃气虚证、脾胃阴虚证和气阴两虚证为主要证型。NIS的数量增多、程度加重及频率增加与晚期肿瘤患者营养不良进展明显相关。慢性炎症可能是肿瘤NIS发生的主要机制,调控免疫及炎症或能改善患者NIS及营养状态。Objective To study the distribution patterns of nutrition impact symptoms(NIS)in advanced cancer patients with malnutrition,explore Traditional Chinese medicine(TCM)syndromes,and analyze the correlation between NIS grading and cancer-related malnutrition.Methods A general information questionnaire,patient-generated subjective global assessment(PG-SGA)scale,NIS grading,and immunoinflammatory indicators were used as survey instruments to analyze clinical characteristics,NIS distribution patterns,TCM syndromes,and the correlation between NIS grading and malnutrition in advanced cancer patients.Results Among 127 advanced cancer patients,19 were moderately malnourished while 108 were severely malnourished.The incidence of NIS in advanced cancer patients with moderate to severe malnutrition was 98.4%,and the mean number of NIS was 2.7 in patients with moderate malnutrition but 5.8 in patients with severe malnutrition.Among the 91 patients,there were 17 cases of spleen and stomach qi deficiency,41 cases of spleen and stomach yin deficiency,and 33 cases of both qi and yin deficiency.There were statistically significant differences in PG-SGA scores and systemic immune inflammation index(SII)among the three syndromes(P<0.05).PG-SGA scores were significantly correlated with the grading of dry mouth,decreased taste,loss of appetite,nausea,vomiting,constipation,abdominal distension/abdominal pain,and fatigue(P<0.05),while prognostic nutritional index(PNI),SII,ALB(albumin,ALB),prealbumin(PAB)were significantly correlated with the grading of dry mouth,loss of appetite,nausea,and constipation(P<0.05).Conclusion Advanced cancer patients with malnutrition are mainly characterized by syndromes of spleen and stomach qi deficiency,spleen and stomach yin deficiency,and both qi and yin deficiency.The increasing number,severity,and frequency of NIS are significantly associated with the progression of malnutrition in advanced cancer patients.Chronic inflammation may be the main mechanism of NIS occurrence in tumor patients,so regulating

关 键 词：肿瘤营养不良 营养影响症状 症状分级 分布规律 中医证型 

分 类 号：R273[医药卫生—中西医结合] R730.6[医药卫生—中医肿瘤科]