肝癌患者行肝动脉化疗栓塞术前营养风险筛查的应用研究

目的 探讨肝癌患者行肝动脉化疗栓塞术前营养风险筛查的应用及对手术疗效、生活质量和生存预后的影响。方法 选取2013年1月至2018年12月首都医科大学附属北京世纪坛医院介入治疗科收治的行肝动脉化疗栓塞术治疗的中晚期肝癌患者180例，根据营养风险筛查2002（NRS 2002）将研究人群分为有营养风险组（NRS 2002≥3分）和无营养风险组（NRS 2002<3分），比较两组患者的临床基线特征、反映营养状况的物理和生化指标以及行肝动脉化疗栓塞术（TACE）手术疗效及并发症和生活质量评分，采用Kaplan-Meier方法对两组患者进行生存分析，比较上消化道出血、肝性脑病等临床终点事件的发生率。结果 纳入标准的180例患者中，无营养风险患者有85例，有营养风险患者有95例，营养风险发生率52.8%。两组患者的肱三头肌皮褶厚度、上臂肌围、体质指数、白蛋白之间存在统计学差异（P<0.05）；两组患者的总蛋白和前蛋白之间没有显著的统计学差异（P>0.05）。两组患者的TACE治疗肿瘤的临床有效率和术后并发症没有显著的差异（P>0.05）。无营养风险患者生活质量评分比有营养风险患者评分高（P<0.05）。有营养风险患者3年生存率为54.74%；无营养风险患者3年生存率为68.24%，存在统计学意义（HR=0.61，P=0.05， 95%CI=0.38~0.98）。肝性脑病、低蛋白血症和贫血的发生率两组之间有统计学差异（P<0.05）。上消化道出血和门脉癌栓堵塞的发生率之间没有统计学差异（P>0.05）。结论 营养风险筛查对于行TACE手术患者具有重要意义，营养风险与临床结局密切相关。

Application of nutritional risk screening in liver cancer patients underwent transcatheter arterial chemoembolization

Objective To explore the application of nutritional risk screening before TACE in patients with liver cancer and its influence on the curative effect,quality of life and prognosis.Methods From January 2013 to December 2018,180 patients with advanced liver cancer treated by TACE were selected from Beijing Shijitan Hospital affiliated to Capital Medical University.According to nutrition risk screening 2002(NRS 2002),the study population was divided into two groups:one group with nutrition risk(NRS 2002≥3 points)and another group without nutrition risk(NRS 2002<3 points).Further,the basic clinical characteristics,physical and biochemical indexes reflecting nutritional status,therapeutic effect,complications and quality of life scores were compared between the two groups.Kaplan Meier method was used to analyze the survival of the patients,and the incidence of other clinical end-point events such as gastrointestinal hemorrhage and hepatic encephalopathy were compared.Results Among the 180 patients who met the inclusion criteria,there were 85 patients without nutritional risk and 95 patients with nutritional risk.The incidence of nutritional risk was 52.8%.There were statistical differences in triceps skinfold thickness,upper arm muscle circumference,body mass index,and albumin between the two groups of patients(P<0.05).There was no statistically significant difference between total protein and preprotein in the two groups of patients(P>0.05).There was no significant difference in clinical effectiveness and postoperative complications of TACE in treating tumors between the two groups of patients(P>0.05).The quality of life score in patients without nutritional risk was higher than that of patients with nutritional risk(P<0.05).The 3-year survival rate of patients with nutritional risk was 54.74%;the 3-year survival rate of patients without nutritional risk was 68.24%,which was statistically significant(HR=0.61,P=0.05,95%CI=0.38~0.98).The incidence of hepatic encephalopathy,hypoalbuminemia,and anemia was statistically different between the two groups(P<0.05).There was no statistical difference between the incidence of upper gastrointestinal bleeding and obstruction of portal vein thrombosis(P>0.05).Conclusions Nutritional risk screening is of great significance for patients undergoing TACE surgery.Nutritional risk is closely related to clinical outcomes,so it is particularly important to screen for patients with nutritional risks as early as possible and to provide interventions.