Objective To investigate the changes in prevalence of nutritional risk and undemutrition in patients with head and neck cancer during radiotherapy.Methods In this longitudinal observational study,a convenience sampling method was used to recruit patients with head and neck cancer who were receiving radiotherapy in Beijing Cancer Hospital.Nutritional Risk Screening 2002 (NRS 2002) was applied to assess the prevalence of nutritional risk in the patients,and Patient-Generated Subjective Global Assessment (PG-SGA) and body composition test to determine the prevalence of malnutrition (undernutrition) before,during and after radiotherapy.Results 56 patients finished the three follow-up exams.Along with the progress of radiotherapy,the scores of NRS 2002 increased gradually (1.64±1.09 vs.2.30 ±1.06 vs.3.14 ±1.07,x2 =46.639,P＜0.001),and the prevalence of nutritional risk also increased gradually (21.43％ vs.37.50％ vs.71.43％,x2 =29.700,P ＜0.001);the total scores of PG-SGA [1 (1-13) vs.6 (1-15) vs.12 (1-18),x2 =63.206,P＜0.001] and dimensions of weight [0 (0-4) vs.1 (0-4) vs.3 (0-6),x2 =40.798,P＜0.001],intake [0 (0-2) vs.1 (0-2) vs.2 (0-4),x2=64.707,P＜0.001] and symptoms [0 (0-7) vs.2 (0-10) vs.6 (0-11),x2 =61.562,P ＜ 0.001] all increased gradually with statistical significance.The prevalence of malnutrition in different stage of radiotherapy were significantly different (x2 =64.999,P ＜ 0.001).The body composition analysis in 40 patients showed that all the indicators of body composition decreased significantly along with the progress of radiotherapy.There was a great loss in patients' body weight during radiotherapy,especially the fat-free mass.Conclusions The prevalence of nutritional risk and undernutrition may increase in patients with head and neck cancer during radiotherapy.Lean body mass accounted for most of the weight loss.We should pay more attention to those patients' nutritional status during radiotherapy.%目的 调查头颈部恶性肿瘤患者放射治疗期间营养风险及营养不足的发生率及其变化.方法 本研究为纵向观察性研究,采用方便取样法选择北京肿瘤医院接受放射治疗的头颈部恶性肿瘤患者为研究对象,在不同放射治疗阶段(放射治疗前、放射治疗中、放射治疗结束时)用营养风险筛查2002(NRS 2002)筛查患者的营养风险发生率,用患者参与主观全面评估(PG-SGA)和体成分测量调查其营养不良(不足)发生率,观察其变化.结果 有56例患者完成3次随访,随着放射治疗的进行,患者的NRS 2002评分逐次增加(1.64±1.09比2.30±1.06比3.14±1.07,x2=46.639,P＜0.001),营养风险的发生率亦逐次增加(21.43％比37.50％比71.43％,x2=29.700,P＜0.001),差异均有统计学意义.随着放射治疗的进行,患者的PG-SGA总分[1(1～13)比6(1～15)比12 (1～18),x2=63.206,P＜0.001]及其中的体质量评分[0 (0～4)比1 (0～4)比3(0～6),x2=40.798,P＜0.001]、进食情况评分[0 (0～2)比1(0～2)比2 (0～4),x2 =64.707,P＜0.001]、症状评分[0(0～7)比2(0 ～ 10)比6(0～11),x2=61.562,P＜0.001]均逐次增加,差异有统计学意义;患者在不同放射治疗阶段的营养不良发生率差异有统计学意义(x2=64.999,P＜0.001).40例患者体成分测量结果显示,随着放射治疗的进行,患者的各项测量指标的数值均逐次下降,差异有统计学意义;患者在放射治疗期间体质量丢失较多,且以去脂体质量丢失为主.结论 随着放射治疗的进行,头颈部恶性肿瘤患者营养风险及营养不足的发生率逐渐增加,且患者的体质量丢失以去脂体质量丢失为主,提示应关注头颈部恶性肿瘤患者在放射治疗期间的营养状况.
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