胃肠道肿瘤患者围化疗期营养状况的评价及对免疫功能的影响

目的:运用患者主观全面评价法(patient generated-subjective global assessment，PG-SGA)和营养风险筛查2002(nutrition risk screening 2002，NRS-2002)并结合实验室指标对围化疗期胃肠道肿瘤患者进行营养评价及免疫功能检测，观察营养不良及营养风险对相关临床指标的影响。方法:收集2012年2月至2014年2月期间于我院诊断为胃肠道恶性肿瘤术后待化疗患者80例，通过PG-SGA评分、NRS-2002评分、体格测量及实验室检测进行营养评价。检测T细胞亚群（CD4+、CD8+、CD4+/CD8+）。以PG-SGA评分作为营养评价指标，将80例化疗前患者分为A组（0-3分）、B组（4-8分）和C组（＞8分），分别测定外周血T淋巴细胞亚群。其中资料完整的45例化疗患者于化疗6周期后重复上述内容，并观察化疗后并发症、平均住院时间。结果:PG-SGA评价结果为营养不良者占68.75%，NRS-2002评价结果营养不良者占42.50%。PG-SGA与NRS-2002分别与其他营养评价指标评价结果间均有显著相关性（P＜0.05）。随着营养不良评分的升高，CD4+和CD4+/CD8+均呈不同程度下降，差异有统计学意义（P＜0.05）。PG-SGA评分与CD4+之间的相关系数r=－0.399(P＜0.01)；PG-SGA与CD4+/CD8+之间的相关系数r=－0.655(P＜0.01)。胃肠道肿瘤患者化疗后营养不良发生率高于化疗前。化疗后与化疗前，CD4+/CD8+明显下降，差异有显著性（P＜0.05）。化疗后营养不良组与营养良好组相比平均住院时间及并发症发生率显著增高（P＜0.05）。与无营养风险组相比，存在营养风险组的平均住院时间及并发症发生率显著增高（P＜0.05）。结论:联合运用PG-SGA、NRS-2002和实验室检测指标有助于提高肿瘤患者营养不良的诊断率。

Patients with gastrointestinal cancer chemotherapy nutritional status assessment and its impact on immune function

Objective:To evaluate the nutritional status and immune function in patients with gastrointestinal neoplasms during perichemotheraputic period by using the Patient Generated-Subjective Global Assessment（PG-SGA) and Nutritional Risk Screening 2002 （NRS-2002) in combination with laboratory tests.Methods:All 80 hospitalized gastrointestinal neoplasms patients who would receive chemotherapy after surgery were collected as research group.The nutritional status was evaluated by PG-SGA score,NRS-2002 score,body assay and laboratory testing.T-lymphocyte subset (CD4+,CD8+,CD4+/CD8+).80 cases of chemotherapy patients were divided into group A(0-3),group B(4-8)and group C(>8) according to PG-SGA grade and T-lymphocyte subsets.Among them,45 cases with after 6 cycles of chemotherapy repeated the above content,meanwhile complications and length of hospitalization were observed after chemotherapy.Results:The incidence of patients with malnutrition according to PG-SGA score was 68.75%,the incidence of patients with malnutrition according to NRS-2002 score was 42.50%.Both PG-SGA and NRS-2002 were significantly correlated with other nutritional assessment methods (P＜0.05).For A,B,C three groups,with malnutrition score increasing,there was significant difference of CD4+ and CD4+/CD8+(P＜0.05).PG-SGA score was negatively correlated with CD4+(r=－0.399,P＜0.01) and CD4+/CD8+(r=－0.655,P＜0.01).The prevalence of malnutrition in patients with post-chemotherapeutic was higher than that in patients with fore-chemotherapy.The ratio of CD4+/CD8+ in patients with post-chemotherapeutic was lower than that of fore-chemotherapy (P＜0.05).Compared with the incidence of complications and the average length of hospitalization in well nourished patients after chemotherapy,those in malnourished patients were significantly higher or longer.Compared with the incidence of complications and the average length of hospitalization in patients without malnutritional risk after chemotherapy,those in patients with malnutritional risk were significantly higher or longer (P＜0.05).Conclusion:The combined use of PG-SGA,NRS-2002 and laboratory index is helpful to improve the diagnosis rate of cancer patients with malnutrition.