口腔肿瘤术后患者放疗前中后期人体成分和生化指标的变化
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摘要
目的观察口腔肿瘤术后患者放疗前中后期的人体成分及生化指标的变化。方法选取上海交通大学医学院附属第九人民医院营养门诊就诊的口腔肿瘤术后患者66例,通过TANITA MC-180身体成分分析仪分别于放疗前2周、放疗中期、放疗后2周对患者体重、基础代谢率、骨骼肌肉量、体脂率等进行测定,检测血总蛋白、白蛋白、前白蛋白、肌酐等生化指标,采用SPSS 23.0软件包对数据进行统计学分析。结果口腔肿瘤术后患者放疗后期体重、体质指数(BMI)、躯干和双上肢及总肌肉量较放疗前、中期下降,放疗中后期躯干和双上肢体脂率较放疗前显著上升(P<0.05)。放疗后期血清白蛋白、肌酐较放疗中期下降,放疗后期前白蛋白比放疗前、中期显著下降(P<0.05)。结论口腔肿瘤术后患者躯干及四肢肌肉量减少、肌肉蛋白丢失是体重下降的主要原因,对准备放疗患者应尽早进行营养干预和营养支持。
Objective To observe the changes of body composition and biochemical indexes in patients with oral cancers before,during and after radiotherapy. Methods Sixty-six patients with oral cancers treatedin Shanghai Ninth People's Hospital were selected.Body weight, body mass index, basal metabolic rate, skeletal muscle mass and body fat rate were measured by TANITA MC-180 body component analysis instrument 2 weeks before, during and 2 weeks after radiotherapy.Total protein, albumin, prealbumin, serum creatinine and other biochemical indexes were determined.SPSS 23. 0 software package was used for data analysis. Results Postoperative body weight, BMI, total muscle mass, trunk and upper extremity muscle mass of patients with oral cancers after radiotherapy were decreased compared with thosebefore and during radiotherapy, and the fat rate of trunk and upper extremity was significantly increased in the middle and late radiotherapy compared with that before radiotherapy (P<0.05).In the age group below 60 years old, the total muscle mass, the muscle mass of the trunk and the left upper limb in the later radiotherapy period decreased compared with thosein the early and middle radiotherapy period, and the fat rate of the left upper limb increased (P<0.05).The body weight, BMI and bilateral calf circumference of patients aged 60 and above in the later stage of radiotherapy were decreased compared with those in the middle stage of radiotherapy, and the total muscle mass, trunk and lower limb muscle mass in the later stage of radiotherapy were significantly decreased compared with thosein the early stage of radiotherapy(P<0.05).The serum albumin and serum creatinine in the postoperative period after radiotherapy were lower than those in the postoperative period after radiotherapy, and the prealbumin in the postoperative period after radiotherapy was significantly lower than those in the preoperative period and the postoperative period after radiotherapy (P<0.05).In the age group below 60 years old, albumin and prealbumin in the later stage of radiotherapy decreased significantly compared with thosebefore radiotherapy (P <0.05).The total protein, albumin and serum creatinine of patients aged 60 years and above decreased in the later stage of radiotherapy compared with the middle stage of radiotherapy, which was statistically significant(P<0.05). Conclusion The main reason of weight loss is the decrease of muscle mass and muscle protein in the trunk and limbs after oral tumor cancers.Nutritional intervention and nutritional support should be provided as early as possible for patients preparing for radiotherapy.
Objective To observe the changes of body composition and biochemical indexes in patients with oral cancers before,during and after radiotherapy. Methods Sixty-six patients with oral cancers treatedin Shanghai Ninth People's Hospital were selected.Body weight, body mass index, basal metabolic rate, skeletal muscle mass and body fat rate were measured by TANITA MC-180 body component analysis instrument 2 weeks before, during and 2 weeks after radiotherapy.Total protein, albumin, prealbumin, serum creatinine and other biochemical indexes were determined.SPSS 23. 0 software package was used for data analysis. Results Postoperative body weight, BMI, total muscle mass, trunk and upper extremity muscle mass of patients with oral cancers after radiotherapy were decreased compared with thosebefore and during radiotherapy, and the fat rate of trunk and upper extremity was significantly increased in the middle and late radiotherapy compared with that before radiotherapy (P<0.05).In the age group below 60 years old, the total muscle mass, the muscle mass of the trunk and the left upper limb in the later radiotherapy period decreased compared with thosein the early and middle radiotherapy period, and the fat rate of the left upper limb increased (P<0.05).The body weight, BMI and bilateral calf circumference of patients aged 60 and above in the later stage of radiotherapy were decreased compared with those in the middle stage of radiotherapy, and the total muscle mass, trunk and lower limb muscle mass in the later stage of radiotherapy were significantly decreased compared with thosein the early stage of radiotherapy(P<0.05).The serum albumin and serum creatinine in the postoperative period after radiotherapy were lower than those in the postoperative period after radiotherapy, and the prealbumin in the postoperative period after radiotherapy was significantly lower than those in the preoperative period and the postoperative period after radiotherapy (P<0.05).In the age group below 60 years old, albumin and prealbumin in the later stage of radiotherapy decreased significantly compared with thosebefore radiotherapy (P <0.05).The total protein, albumin and serum creatinine of patients aged 60 years and above decreased in the later stage of radiotherapy compared with the middle stage of radiotherapy, which was statistically significant(P<0.05). Conclusion The main reason of weight loss is the decrease of muscle mass and muscle protein in the trunk and limbs after oral tumor cancers.Nutritional intervention and nutritional support should be provided as early as possible for patients preparing for radiotherapy.
引文
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4陈小岑,魏婷婷,阎玲.肿瘤放疗患者营养状况与营养干预的研究进展[J].天津护理,2016,24(4):366-368.
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7邓明辉.湖南地区口腔颌面部恶性肿瘤发病情况调查分析[J]..长沙:中南大学,2009.
8 Calder PC.Immunonutrition[J].BMJ,2003,327(7407):117-118.
9 Stableforth WD,Thomas S,Lewis SJ.A systematic review of the role of immunonutrition in patients undergoing surgery for head and neck cancer[J].Int J Oral Maxillofac Surg,2009,38(2):103-110.
10中国抗癌协会头颈肿瘤专业委员会.头颈部肿瘤综合治疗专家共识[J].中华耳鼻咽喉头颈外科杂志,2010,45(7):535-541.
11 Thiel HJ,Fietkau R,Sauer R.Malnutrition and the role of nutritional support for radiation therapy patients[J].Recent Results Cancer Res.1988;108:205-226.
12 Gellrich NC,Handschel J,Holtmann H,et al.Oral cancer malnutrition impacts weight and quality of life[J].Nutr.2015,7(4):2145-2160.
13王艳莉,龚丽青,史双,等.蛋白质摄入量对头颈部肿瘤放化疗期间人体成分及生活质量的影响[J].肿瘤代谢与营养电子杂志2017,4(4):414-420.
2刘善廷,吴俊福,郑荣寿,等.2009年中国口腔癌和咽喉癌发病与死亡情况分析[J].中华预防医学杂志,2013,47(7):586-591.
3周福祥.放疗性营养不良临床评估及治疗[J].肿瘤代谢与营养电子杂志,2014,1(2):21-25.
4陈小岑,魏婷婷,阎玲.肿瘤放疗患者营养状况与营养干预的研究进展[J].天津护理,2016,24(4):366-368.
5 Hills A,Byrne N.Malays.Bioelectrical impedance and body composition assessment[J].Nutr.1998,4(1):107-112.
6 Ritchie JD,Miller CK,Smiciklas-Wright H.Tanita foot-to-foot bioelectrical impedance analysis system validated in older adults[J].J Am Diet Assoc,2005,105(10):1617-1619.
7邓明辉.湖南地区口腔颌面部恶性肿瘤发病情况调查分析[J]..长沙:中南大学,2009.
8 Calder PC.Immunonutrition[J].BMJ,2003,327(7407):117-118.
9 Stableforth WD,Thomas S,Lewis SJ.A systematic review of the role of immunonutrition in patients undergoing surgery for head and neck cancer[J].Int J Oral Maxillofac Surg,2009,38(2):103-110.
10中国抗癌协会头颈肿瘤专业委员会.头颈部肿瘤综合治疗专家共识[J].中华耳鼻咽喉头颈外科杂志,2010,45(7):535-541.
11 Thiel HJ,Fietkau R,Sauer R.Malnutrition and the role of nutritional support for radiation therapy patients[J].Recent Results Cancer Res.1988;108:205-226.
12 Gellrich NC,Handschel J,Holtmann H,et al.Oral cancer malnutrition impacts weight and quality of life[J].Nutr.2015,7(4):2145-2160.
13王艳莉,龚丽青,史双,等.蛋白质摄入量对头颈部肿瘤放化疗期间人体成分及生活质量的影响[J].肿瘤代谢与营养电子杂志2017,4(4):414-420.