营养风险筛查2002在老年恶性肿瘤患者化疗中的应用研究
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摘要
目的:了解NRS2002在预估老年肿瘤患者化疗不良反应的潜在作用及相关影响因素,探讨潜在的化疗不良事件的干预措施。方法:2016年7月至2017年2月选择在我院肿瘤内科就诊的149例老年肿瘤化疗患者作为研究对象,入院24 h内完善NRS2002评分及相关病史采集,评估化疗不良反应分级。结果:149例患者中,有营养不良风险(NRS2002评分≥3分)的老年肿瘤患者占43.6%,无营养风险占56.4%,其中年龄、肿瘤类别分布、化疗不良反应分级、WBC、Hb、Scr、UA及血清K~+组间差异有统计学意义(P<0.05)。相关性分析结果显示:不良反应分级与NRS2002评分呈正相关性,与WBC、Hb、SCr、UA及K~+、Ca~(2+)呈负相关性。线性回归分析提示NRS2002评分的高低与老年肿瘤患者化疗不良反应分级显著正相关,而SCr则是一个负性预测因子。结论:NRS2002可准确预估老年肿瘤化疗患者面临的潜在化疗风险,早期纠正贫血或可缩小老年肿瘤患者的化疗不良反应风险;肾功不全不再是化疗的绝对禁忌证。
Objective: To investigate the relevant influencing factors of NRS2002 in elderly cancer patients for chemotherapy,and to explore the potential interventions for side effects of chemotherapies. Methods: From July 2016 to February 2017,choose 149 cases in our hospital oncology department of elderly cancer patients for chemotherapy as the research. The NRS2002 score and relevant medical history were collected within 24 h of admission,and the side-effect of chemotherapy was evaluated. Results: The 149 patients with a mean age( 68. 70 ± 3. 64) years old consisted of patients with malnutrition risk( 43. 6%,NRS2002 scores ≥3) and no risk of malnutrition( 56. 4%,NRS2002 scores < 3),in which two groups there were significant differences in age,tumor type distribution,chemotherapy side effect classification,WBC,Hb,Scr,UA and serum K+level. Correlation analysis results prompted that NRS2002 scores showed positive correlation with side effect,and had a negative correlation with WBC,Hb,SCr,UA,K~+ and Ca~(2+)and level. Linear regression analysis showed that side effect classification was positively correlated with NRS2002 in elderly cancer patients for chemotherapy,while negatively correlated with SCr level. Conclusion: NRS2002 could accurately predict the potential side effect in elderly cancer patients for chemotherapy,and to guide the clinical intervention in advance. Hemoglobin may also be one of the predictors for malnutrition risk and chemotherapy side effect in elderly cancer patients. Renal insufficiency is no longer the absolute contraindication of chemotherapy.
Objective: To investigate the relevant influencing factors of NRS2002 in elderly cancer patients for chemotherapy,and to explore the potential interventions for side effects of chemotherapies. Methods: From July 2016 to February 2017,choose 149 cases in our hospital oncology department of elderly cancer patients for chemotherapy as the research. The NRS2002 score and relevant medical history were collected within 24 h of admission,and the side-effect of chemotherapy was evaluated. Results: The 149 patients with a mean age( 68. 70 ± 3. 64) years old consisted of patients with malnutrition risk( 43. 6%,NRS2002 scores ≥3) and no risk of malnutrition( 56. 4%,NRS2002 scores < 3),in which two groups there were significant differences in age,tumor type distribution,chemotherapy side effect classification,WBC,Hb,Scr,UA and serum K+level. Correlation analysis results prompted that NRS2002 scores showed positive correlation with side effect,and had a negative correlation with WBC,Hb,SCr,UA,K~+ and Ca~(2+)and level. Linear regression analysis showed that side effect classification was positively correlated with NRS2002 in elderly cancer patients for chemotherapy,while negatively correlated with SCr level. Conclusion: NRS2002 could accurately predict the potential side effect in elderly cancer patients for chemotherapy,and to guide the clinical intervention in advance. Hemoglobin may also be one of the predictors for malnutrition risk and chemotherapy side effect in elderly cancer patients. Renal insufficiency is no longer the absolute contraindication of chemotherapy.
引文
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[13]Wei TT,Wang H,Gao Y,et al.Nutritional risk screening and nutritional support of inpatients in department of gastroenterology,the first Hospital of peking university,2015[J].Practical Preventive Medicine,2017,24(4):419-422.[魏天桐,王卉,高媛,等.北京大学第一医院消化内科2015年住院患者营养风险筛查和营养支持调查[J].实用预防医学,2017,24(4):419-422.]
[14]Extermann M,Boler I,Reich RR,et al.Predicting the risk of chemotherapy toxicity in older patients:The chemotherapy risk assessment scale for high-age patients(CRASH)score[J].Cancer,2012,118(13):3377-3386.
[15]Hurria A,Togawa K,Mohile SG,et al.Predicting chemotherapy toxicity in older adults with cancer:a prospective multicenter study[J].J Clin Oncol,2011,29(25):3457-3465.
[16]Shao YJ,Liu JL,Bai CM,et al.Risk factors associated with serious adverse reactions to cancer chemotherapy[J].Oncology Progress,2017,15(8):942-946.[邵亚娟,刘俊良,白春梅,等.肿瘤患者化疗后严重不良反应相关因素分析[J].癌症进展,2017,15(8):942-946.]
[17]Zhang YR,Li CX,Li YQ,et al.Analysis of nutritional risk and application of nutritional support in 80 patients with malignant tumor during chemoradiotherapy[J].Electronic Jourmal of Metabolism and Nutrition of Cancer,2016,3(1):49-51.[张亚茹,李春霞,李燕琴,等.80例肿瘤放化疗患者营养风险及营养支持状况分析[J].肿瘤代谢与营养电子杂志,2016,3(1):49-51.]
[2]Ottery FD.Definition of standardized nutritional assessment and interventional pathways in oncology[J].Nutrition,1996,12(1 Suppl):15-19.
[3]Jiang ZM,Yang J,Yu K,et al.The nutrition risk screening 2002 utility form tool and notes which included in the clinical guidelines and the national family planning commission industry standard[J].Chinese Journal of Clinical Nutrition,2017,25(5):263-267.[蒋朱明,杨剑,于康,等.列入临床诊疗指南和国家卫生和计划生育委员会行业标准的营养风险筛查2002工具实用表格及注意事项[J].中华临床营养杂志,2017,25(5):263-267.]
[4]Yan FQ,Zhu H,Duan XY,et al.Application of nutritional risk screening 2002,mini nutritional assessment,and clinical laboratory measurements in nutrition survey of hospitalized elderly patients[J].Parenteral&Enteral Nutrition,2016,23(6):369-372.[严凤琴,朱虹,段晓宇,等.营养评定工具NRS2002、MNA和实验室检查在老年住院病人营养调查中的应用[J].肠外与肠内营养,2016,23(6):369-372.]
[5]Yun HJ,Lee WJ,Byeon JH,et al.Metronomic chemotherapy with capecitabine for metastatic colorectal cancer in very elderly patients[J].Korean J Intern Med,2016,32(5):926-929.
[6]Mitchell AJ.Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders[J].Journal of Clinical Oncology,2007,25(29):4670.
[7]Kang SH,Cho KH,Park JW,et al.Geriatric Nutritional Risk Index as a prognostic factor in peritoneal dialysis patients[J].Peritoneal Dialysis International Journal of the International Society for Peritoneal Dialysis,2013,33(4):405.
[8]Bouillanne O,Morineau G,Dupont C,et al.Geriatric Nutritional Risk Index:a new index for evaluating at-risk elderly medical patients[J].American Journal of Clinical Nutrition,2005,82(4):777-783.
[9]Zhou YX,Chen L,Jiang P.Effects of individualized nutritional intervention based on nutritional risk assessment on nutritional status and life quality of elderly chemotherapy patients with advanced colorectal cancer[J].Journal of Clinical Research,2017(8):1498-1500.[周玉霞,陈黎,蒋平.基于营养风险评估的个体化营养干预对老年晚期结直肠癌化疗患者营养状况及生活质量的影响[J].医学临床研究,2017(8):1498-1500.]
[10]Orellkotikangas H,Osterlund P,Saarilahti K,et al.NRS-2002for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients[J].Supportive Care in Cancer,2015,23(6):1495.
[11]Wang TT,Shen WZ,Wang H,et al.Relationship between nutritional status and chemotherapy side effects,efficacy and quality of life in patients with gastric cancer[J].Oncology Progress,2017,15(8):973-975.[王婷婷,沈卫章,王辉,等.胃癌化疗患者营养状况与化疗不良反应及疗效和生活质量的关系[J].癌症进展,2017,15(8):973-975.]
[12]Wu HT,Wang C,Wang YZ,et al.The investigation of malnutrition status of 744 elderly patients in hospital and their correlation with different clinical factors[C].2015 China International Cancer Nutrition BBS.The Nutritional Peak of Cancer on Both Sides of The Taiwan Strait is BBS,2015.[吴海涛,王畅,王轶卓,等.744例住院老年肿瘤患者营养不良状况调查及其与不同临床因素相关性分析[C].2015中国国际肿瘤营养学论坛、海峡两岸肿瘤营养高峰论坛,2015.]
[13]Wei TT,Wang H,Gao Y,et al.Nutritional risk screening and nutritional support of inpatients in department of gastroenterology,the first Hospital of peking university,2015[J].Practical Preventive Medicine,2017,24(4):419-422.[魏天桐,王卉,高媛,等.北京大学第一医院消化内科2015年住院患者营养风险筛查和营养支持调查[J].实用预防医学,2017,24(4):419-422.]
[14]Extermann M,Boler I,Reich RR,et al.Predicting the risk of chemotherapy toxicity in older patients:The chemotherapy risk assessment scale for high-age patients(CRASH)score[J].Cancer,2012,118(13):3377-3386.
[15]Hurria A,Togawa K,Mohile SG,et al.Predicting chemotherapy toxicity in older adults with cancer:a prospective multicenter study[J].J Clin Oncol,2011,29(25):3457-3465.
[16]Shao YJ,Liu JL,Bai CM,et al.Risk factors associated with serious adverse reactions to cancer chemotherapy[J].Oncology Progress,2017,15(8):942-946.[邵亚娟,刘俊良,白春梅,等.肿瘤患者化疗后严重不良反应相关因素分析[J].癌症进展,2017,15(8):942-946.]
[17]Zhang YR,Li CX,Li YQ,et al.Analysis of nutritional risk and application of nutritional support in 80 patients with malignant tumor during chemoradiotherapy[J].Electronic Jourmal of Metabolism and Nutrition of Cancer,2016,3(1):49-51.[张亚茹,李春霞,李燕琴,等.80例肿瘤放化疗患者营养风险及营养支持状况分析[J].肿瘤代谢与营养电子杂志,2016,3(1):49-51.]