原发性肝癌肝动脉化疗栓塞术术前营养风险筛查的意义及个体化营养干预效果分析

  目的  了解原发性肝癌介入治疗患者术前营养需求和生活质量状况，分析个体化营养干预措施对其影响效果。  方法  选取2018年12月—2019年12月首都医科大学附属北京朝阳医院收治的择期行肝动脉化疗栓塞术(TACE)的120例原发性肝癌患者纳入研究，按随机数字表法分为观察组和对照组各60例，术前均进行欧洲营养风险筛查量表2002(NRS2002)及生活质量量表(EORTC QLQ-C30)筛查，对照组患者围手术期行常规饮食指导，观察组患者行个体化营养干预，随访3个月，观察和比较2组患者的NRS2002、EORTC QLQ-C30评分、肝功能指标(ALT、AST、GGT)及营养指标(BMI、ALB)变化情况。  结果  (1) 120例原发性肝癌患者术前营养状态差，生命质量低；(2)2组患者干预前NRS2002、EORTC QLQ-C30评分、肝功能和营养指标比较，差异均无统计学意义(均P > 0.05)；(3)随访3个月，观察组患者NRS2002、EORTC QLQ-C30评分改善程度显著高于对照组(t_NRS2002=9.076，P=0.003)，肝功能指标(ALT、AST、GGT)低于对照组(t_ALT=-7.623，P < 0.001；t_AST=-8.816，P < 0.001；t_GGT=-12.476，P < 0.001)，营养指标(BMI、ALB)显著高于对照组(t_BMI=6.578，P < 0.001；t_ALB=3.593，P < 0.001)。  结论  原发性肝癌患者术前营养状态差，生活质量低，采用个体化营养干预可有效改善患者营养状态、生活质量和肝功能，具有较好的临床推广应用前景。 

Significance of nutritional risk screening before transcatheter arterial chemoembolization for primary liver cancer and the effect of individualised nutritional intervention

  Objective  To understand the preoperative nutritional needs and quality of life of patients with primary liver cancer treated with interventional therapy and to analyse the effect of individual nutritional interventions.  Methods  A total of 120 primary liver cancer patients undergoing transcatheter arterial chemoembolization (TACE) from December 2018 to December 2019 were included in the study. They were divided into the observation group and control group according to the random number table method with 60 cases in each group. All patients were screened using the preoperative Nutritional Risk Screening 2002 (NRS2002) scale and Quality of Life Scale (EORTC QLQ-C30) before operation. The patients in the control group were provided perioperative regular diet guidance, whereas those in the observation group were given individualised nutritional intervention. The patients were followed up for 3 months. The NRS2002 score, EORTC QLQ-C30 score, liver function index (ALT, AST, GGT) and nutritional index (BMI, ALB) between the two groups were observed and compared.  Results  (1) A total of 120 patients with primary liver cancer had poor preoperative nutritional status and low quality of life. (2) No statistically significant difference was observed in the NRS2002 score, EORTC QLQ-C30 score, liver function and nutritional index between the two groups before intervention (all P > 0.05). (3) After three months of follow-up, the observation group had improved NRS2002 and EORTC QLQ-C30 scores compared with the control group (all P < 0.05). Moreover, the observation group had lower liver function indexes (t_ALT=-7.623, t_AST=-8.816, t_GGT=-12.476) and higher nutritional indexes (t_BMI=6.578, t_ALB=3.593) compared with the control group (all P < 0.001).  Conclusion  Patients with primary liver cancer have poor preoperative nutritional status and low quality of life. Individualised nutritional intervention can effectively improve patients' nutritional status, quality of life and liver function, indicating that it has a good clinical application prospect.