营养咨询联合口服营养补充对食管癌放疗患者临床结局的影响

摘要

目的：评价营养咨询联合口服补充高脂肪、高蛋白肿瘤全营养配方食品（倍康素）对食管癌放疗患者营养状况和临床结局的影响。方法选取80例能够经口进食且营养风险筛查2002（ NRS2002）≥3分的食管癌放疗患者，随机数字表方法分为研究组（ n＝41，营养咨询＋口服补充肿瘤全营养配方食品）和对照组（n＝39，营养咨询），比较放疗前后两组患者的能量摄入、营养状况、放疗不良反应发生率等。结果放疗过程中，与对照组比较，研究组患者每天口服营养补充能量显著增加[（2445±686） kJ比（1747±456） kJ， P＝0．003]；放疗前后对比，研究组患者前白蛋白和转铁蛋白水平显著升高[（17．35±5．83） mg／L比（20．15±6．02） mg／L， P＝0．008；（213．74±52．66） mg／L比（264．19±43．78） mg／L， P＝0．002]。此外，与对照组比较，研究组患者Ⅲ级放射性食管炎和Ⅲ级放射性皮肤损伤的发生率显著降低（24％比38％， P＝0．000；27％比41％， P＝0．000）。结论营养咨询联合口服营养补充可改善食管癌放疗患者的营养状况，降低放疗相关毒副反应发生率，有助于改善临床结局。%Objective To investigate the effect of nutritional counseling combined with oral high-fat, high-protein nutritional supplement (Ensource) on nutritional status and clinical outcomes of esophageal cancer patients under radiotherapy treatment.Methods Totally 80 esophageal cancer patients under radiotherapy treat-ment who were able to take oral feeding and with Nutritional Risk Screening 2002 (NRS 2002) score≥3 were se-lected and divided into a study group (n=41, nutritional counseling combined with oral nutritional supplements) and a control group ( n=39, nutritional counseling) with a random number table.Energy intake, nutritional sta-tus, and incidences of radiotherapy complications of the two groups before and after radiotherapy were compared. Results Energy intakes in the study group increased significantly during radiotherapy compared with the control group [ (2 445 ±686) kJ vs.(1 747 ±456) kJ, P=0.003];and the level of prealbumin and transferrin were increased significantly compared with before radiotherapy [ (17.35 ±5.83) mg/L vs.(20.15 ±6.02) mg/L, P=0.008;(213.74 ±52.66) mg/L vs.(264.19 ±43.78) mg/L, P=0.002].Besides, compared with the control group, incidence of radiation esophagitis ( GradeⅢ) and radiation skin injury ( GradeⅢ) in the study group decreased significantly (24%vs.38%, P=0.000;27%vs.41%, P=0.000).Conclusion Nutritional counseling combined with oral nutritional supplements in esophageal cancer patients could help improve the patients'nutritional profile and decrease the incidence of complications related with radiotherapy.