头颈部恶性肿瘤患者放射治疗期间骨骼肌量变化及其影响因素分析

目的:观察头颈部恶性肿瘤患者放射治疗期间骨骼肌量的变化,并分析其影响因素。方法:采用便利取样方法,选取2017年3月至2019年9月在北京市某专科肿瘤医院放射治疗科接受放射治疗的头颈部恶性肿瘤患者为研究对象,应用患者参与主观全面评定(Patient Generated Subjective Global Assessment,PGSGA)的症状部分评估患者在放疗开始前(T1)、放疗中期(T2)、放疗结束时(T3)的营养相关症状(NutritionImpactSymptoms,NIS),用24h膳食回顾法记录膳食摄入情况并采用生物电阻抗分析法测定骨骼肌量变化情况,采用广义估计方程(GeneralizedEstimatingEquations,GEE)分析患者骨骼肌量变化的影响因素。结果:共459例患者完成3次测评。在3个测评时间点,骨骼肌量分别为(26.31±5.08)kg、(25.60±4.83)kg、(24.62±4.68)kg;NIS发生率分别为38.1%(175/459)、93.2%(428/459)、95.4%(438/459);标准化每日能量摄入量(standardDailyEnergyIntake,stDEI)分别为(24.94±8.51)kcal/(kg·day)、(20.47±9.14)kcal/(kg·day)、(18.23±9.75)kcal/(kg·day),标准化每日蛋白摄入量(standard Daily Protein Intake,stDPI)分别为(0.98±0.39)g/(kg·day)(、0.86±0.39)g/(kg·day)、(0.84±0.51)g/(kg·day);随放射治疗的进行,患者骨骼肌量逐渐下降、NIS得分逐渐增加、能量及蛋白质摄入逐渐减少。骨骼肌量变化与放疗前是否手术、膳食能量摄入量及NIS得分密切相关。结论:头颈部恶性肿瘤放射治疗患者治疗后骨骼肌量减少,放疗前未手术、膳食能量摄入不足及NIS重的患者骨骼肌量减少多。提示应重视未手术患者,加强营养相关症状管理和膳食干预,以减轻患者骨骼肌量的丢失。

The change of skeletal muscle mass and its influencing factors in Head and Neck Cancer patients treated with radiotherapy

Objective:To observe the change of skeletal muscle mass in patients with Head and Neck Cancer during radiotherapy and analyze its influencing factors.Methods:Patients with Head and Neck Cancer treated with radiotherapy in a cancer hospital in Beijing from March 2017 to September 2019 were recruited.The symptom section of Patient Generated Subjective Global Assessment(PG-SGA)was used to assess the Nutrition Impact Symptoms(NIS)of patients before(T1),during(T2)and at the end(T3)of the radiotherapy.Dietary intake was recorded by 24-hour dietary recall and skeletal muscle mass were measured by bioelectrical impedance analysis.Generalized Estimating Equations(GEE)were used to analyze the influencing factors of skeletal muscle mass of head and neck cancer patients during radiotherapy.Results:Totally 459 patients were completely investigated.At the three evaluation time points,the skeletal muscle mass was(26.31±5.08)kg,(25.60±4.83)kg,(24.62±4.68)kg respectively;the incidence of NIS was 38.1%(175/459),93.2%(428/459),95.4%(438/459)respectively;standard daily energy intake(stDEI)was(24.94±8.51)kcal/(kg·day),(20.47±9.14)kcal/(kg·day),(18.23±9.75)kcal/(kg·day)respectively,and standard daily protein intake(stDPI)was(0.98±0.39)g/(kg·day),(0.86±0.39)g/(kg·day),(0.84±0.51)g/(kg·day)respectively.With the progress of radiotherapy,the patient’s skeletal muscle mass gradually decreased,NIS increased,and energy and protein intake declined.Changes in skeletal muscle mass of patients were closely related to whether they had undergone surgery before radiotherapy,dietary energy intake and NIS scores.Conclusion:Patients with radiation therapy have reduced skeletal muscle mass after treatment,and patients with non-surgical,insufficient dietary energy intake and NIS have a greater reduction in skeletal muscle mass.It is suggested that attention should be paid more to non-surgical patients,and nutritionrelated symptoms management and dietary intervention should be strengthened to reduce the loss of skeletal muscle mass.