50例口腔鳞癌患者治疗过程中营养状况改变及影响因素分析

目的： 探讨口腔鳞癌（oral squamous cell carcinoma,OSCC）患者在治疗过程中营养状况的改变,并分析其影响因素。方法： 通过人体测量（体重、身体质量指数、腰围、左右上臂中周径）,实验室检查（血清前白蛋白、血清白蛋白、转铁蛋白、25羟维生素D）记录50例口腔鳞癌患者术前,术后2天、1个月、3个月的营养状况,观察改变程度及影响因素。采用SPSS 24.0软件包对数据进行统计学分析,利用二元logistic回归模型分析口腔鳞癌患者营养风险的影响因素。结果： 单因素和多因素分析结果显示,高年龄段（OR=1.127,95%CI: 1.053~1.207)、低文化水平 (OR=5.250, 95%CI: 1.147~21.796)、吸烟（OR=6.182,95%CI: 1.631~23.433)、饮酒（OR= 5.227,95%CI: 1.336~20.450) 、放化疗（OR=3.984,95%CI: 1.199~13.242)、皮瓣重建术（OR=8.000, 95%CI: 2.060~31.068)、气管切开术（OR=3.960, 95%CI: 1.069~14.671）、颈淋巴结转移（OR=4.821,95%CI: 1.418~16.399) 、颊癌（OR=9.000, 95%CI:1.140~71.038）、舌癌（OR=7.200,95%CI: 1.081~47.962) 、肿瘤T3~T4分期（OR=3.542,95%CI: 1.066~11.771）为口腔鳞癌患者营养风险的独立影响因素。结论： 患者一般人口学特征中的高年龄、低文化水平、吸烟史、饮酒史,治疗方式中的放化疗、皮瓣重建术、气管切开术,临床因素中的颊癌、舌癌、高分期、颈淋巴结转移均影响治疗过程中的营养水平。

Influencing factors of nutritional status and change in 50 patients with oral squamous cell carcinoma during treatment

PURPOSE: To investigate the changes of nutritional status in patients with oral squamous cell carcinoma(OSCC) and analyze the influencing factors during treatment. METHODS: Anthropometry (weight, BMI, waistline, middle circumference of left and right upper arms) and laboratory index(serum prealbumin, serum albumin, transferrins, 25-hydroxyvitamin D) were measured to represent the nutritional status of 50 patients with OSCC before operation, two days, one month and three months after operation. SPSS 24.0 software package was used for statistical analysis of the data, and influencing factors of nutrition risk in OSCC patient were analyzed with binary logistic regression model. RESULTS: Univariate and multivariate analysis showed that advanced age(OR=1.127,95%CI: 1.053-1.207), low educational level (OR=5.250, 95%CI: 1.147-21.796), smoking(OR=6.182, 95%CI: 1.631-23.433), alcohol use(OR=5.227, 95%CI: 1.336-20.450), chemoradiotherapy (OR=3.984, 95%CI: 1.199-13.242), free flap surgery (OR=8.000, 95%CI: 2.060-31.068), tracheostomy(OR=3.960, 95%CI: 1.069-14.671), cervical lymph node metastasis(OR=4.821, 95%CI: 1.418-16.399), buccal carcinoma(OR=9.000, 95%CI:1.140-71.038), tongue cancer(OR=7.200, 95%CI: 1.081-47.962), tumor stage T3-4(OR=3.542, 95%CI: 1.066-11.771) were independent influencing factors of the nutritional status of patients with OSCC. CONCLUSIONS: Aging, low educational level, smoking history and drinking history in the general demographic characteristics of patients, and chemoradiotherapy, free flap surgery, tracheostomy during treatment, as well as buccal carcinoma, tongue cancer, advanced stage and cervical lymph node metastasis are clinical characteristics, which affect the nutrition level during the treatment for OSCC patients.