三种营养不良诊断标准在头颈部恶性肿瘤放疗病人中的应用研究

目的:采用不同营养不良评定标准,描述并比较头颈部恶性肿瘤病人在放疗期间营养不良的变化情况。方法:在北京大学肿瘤医院放疗科选取拟接受放疗的头颈部恶性肿瘤病人,分别在放疗前、放疗中期和放疗结束时随访。采用营养不良评定标准全球领导人共识(GLIM)标准、欧洲肠外肠内营养学会2015年营养不良专家共识(ESPEN 2015)和病人参与主观全面评定(PG-SGA)进行营养评定,其中,营养筛查采用营养风险筛查2002,肌肉量评价采用生物电阻抗分析法测得的四肢骨骼肌指数和去脂体质指数。结果:共纳入502名头颈部恶性肿瘤病人。随着放疗进行,营养风险的比例显著增加;三种标准诊断的营养不良比例均显著增加;且三种标准得到的结果一致性均较差(0.303≤Kappa≤0.681)。结论:头颈部恶性肿瘤病人在放疗期间的营养风险和营养不良比例均显著增加,不同营养不良诊断标准得出的结果差异明显。建议结合临床结局指标进行评价研究,使其更具临床意义。

Application of three diagnostic criteria of malnutrition in patients with head and neck cancer during radiotherapy

Objective: To describe and compare the prevalence of malnutrition in patients with head and neck cancer(HNC)during radiotherapy by using different diagnostic criteria. Methods: Patients with HNC who planned to receive radiotherapy were recruited from the radiotherapy department of Peking University Cancer Hospital. Data were collected at three-time points: before, during, and after treatment. Global Leadership Initiative on Malnutrition(GLIM criteria), European Society of Clinical Nutrition and Metabolism consensus 2015(ESPEN 2015 criteria), and patientgenerated subjective global assessment(PG-SGA) were used for nutritional assessment. Nutritional risk screening 2002 was used for nutritional screening. The body composition was tested with bioelectrical impedance analysis. Appendicular skeletal muscle index and fat-free mass index were used for evaluating reduced muscle mass. Results: 502 HNC patients were enrolled. With the progress of radiotherapy, the proportion of nutritional risk increased significantly;the proportion of malnutrition diagnosed by the three criteria increased significantly;and the consistency of the results obtained by the three criteria was poor(0.303 ≤ Kappa ≤ 0.681). Conclusion: The nutritional risk and malnutrition ratio of patients with HNC during radiotherapy were significantly increased, and the results obtained by different malnutrition diagnostic criteria were significantly different. It is recommended that the evaluation study should be combined with clinical outcome index to make it more clinically significance.