目的 调查与评估肿瘤患儿从诊断到治疗 6 个月期间的营养风险和营养状况;比较淋巴瘤与实体瘤患儿的营养状 况。 方法 回顾性分析 2019 年 7 月至 2021 年 11 月北京儿童医院肿瘤中心肿瘤内科收治的 76 例初发恶性肿瘤患儿的营养状 况。 测量化疗前、化疗后 1 个月、3 个月及 6 个月时的体重、身高和上臂围;采用儿童肿瘤营养风险筛查工具( SCAN)对此 4 个 时间点行营养风险筛查并评估营养状况;调查 4 个时间点的 24 h 膳食摄入及血常规;通过病历收集化疗后 1 个月的并发症及 治疗 6 个月期间的营养治疗情况;比较淋巴瘤(43 例)与实体瘤(33 例)两组患儿的营养状况。 结果 76 例患儿化疗前营养不 良发生率 15. 8%(12 / 76),化疗后 1 个月 32. 9%(25 / 76),3 个月 25. 0%(19 / 76),6 个月 26. 3%(20 / 76),4 个时间点之间差异 有统计学意义(P<0. 001)。 化疗前超重/ 肥胖率 10. 5%(8 / 76),化疗后 1 个月 7. 9%(6 / 76),3 个月 5. 3%(4 / 76),6 个月 6. 6% (5 / 76),4 个时间点之间差异有统计学意义(P= 0. 044);营养不良评分、体质指数(BMI)、上臂围、血红蛋白、前白蛋白、营养风 险筛查评分和总能量摄入在 4 个时间点之间差异均有统计学意义(P<0. 001);化疗后 3 个月内变化大,化疗后 1 个月营养状 况最差。 两组比较:化疗后 6 个月淋巴瘤组和实体瘤组营养不良评分[(0±0. 9)分比(-0. 5±0. 9)分]、BMI[(15. 9±2. 1) kg / m 2 比(14. 8±2. 2)kg / m 2 ]、上臂围[(17. 4±2. 0)cm 比(16. 2±2. 9)cm]、SCAN 分数[1(1,9)分比 2(1,9)分]、血红蛋白[(103. 0± 15. 0)g / L 比(94. 2±13. 5)g / L]、营养不良例数[7 例(16. 3%)比 13 例(39. 4%)],淋巴瘤组均优于实体瘤组,差异有统计学意 义(P<0. 05)。 结论 鉴于采用高强度方案化疗的儿童营养状况不容乐观,应强化营养筛查和评估,及早发现有营养风险的患 儿,积极干预,提高患儿对化疗的耐受性和生命质量。

Objective To investigate and evaluate the malnutrition risk and nutritional status of children with cancer from diagnosis to treatment for 6 months To compare the nutritional status of children with lymphoma and solid tumor. Method The nutritional status of 76 children with primary malignant tumors treated in the Department of oncology of Beijing Children's Hospital from July 2019 to November 2021 was analyzed retrospectively. Weight height and upper arm circumference MUAC before initial treatment 1 month 3 months and 6 months after chemotherapy were measured. Nutritional risk screening and nutritional status assessment were conducted at these four time points. The 24-hour dietary intake and blood examination were investigated at the four time points. The complications one month after chemotherapy and nutritional support during 6 months of treatment were collected through medical records. The nutritional status of children with lymphoma and solid tumor were compared. Result The incidence of malnutrition in 76 children before chemotherapy was 15. 8% 12 / 76 32. 9% 25 / 76 at 1 month 25. 0% 19 / 76 at 3 months and 26. 3% 20 / 76 at 6 months after chemotherapy. There were significant differences among the four time points P < 0. 001 . The overweight / obesity rate was 13. 2% 10 / 76 before chemotherapy 7. 9% 6 / 76 at 1 month 5. 3% 4 / 76 at 3 months and 6. 6% 5 / 76 at 6 months after chemotherapy. The difference between the four time points was statistically significant P < 0. 001 There were significant differences in malnutrition score BMI upper arm circumference scan score and total energy intake among the four time points P < 0. 001 . After 3 months of chemotherapy the nutritional status was the worst in 1 month. Comparison between the two groups Six months after chemotherapy dystrophy score 0±0. 9 vs -0. 5±0. 9 BMI 15. 9±2. 1 kg / m 2 vs 14. 8±2. 2 kg / m 2 upper arm circumference 17. 4±2. 0 cm vs 16. 2±2. 9 cm SCAN score 1 1 9 vs 2 1 9 hemoglobin 103. 0±15. 0 g / L vs 94. 2±13. 5 g / L number of malnutrition cases 7 16. 3% vs 13 39. 4% lymphoma group was superior to solid tumor group the difference was statistically significant P< 0. 05 . Conclusion In view of the poor nutritional status of children receiving highintensity chemotherapy nutritional screening and evaluation should be strengthened to find children with nutritional risks as early as possible and actively intervene to improve their tolerance to chemotherapy and quality of life.