目的 评估鼻咽癌患者放疗前后营养状况与放射性口腔黏膜炎(ROM)的相关性,为临床提高放疗效果,降低放疗并发 症,改善营养供应提供参考依据。 方法 前瞻性纳入 2020 年 5 月至 2022 年 5 月于江苏省人民医院首次确诊鼻咽癌患者共 154 例 为研究对象,接受强调适形放疗(IMRT)或者放化疗,至少 4 周。 比较放疗前和放疗 4 周后的营养指标,包括体重、体质指数 (BMI)、血红蛋白、白蛋白和前白蛋白水平以及营养风险筛查 2002(NRS 2002)评分,放疗后根据美国常见不良反应术语评定标准 (CTCAE 5. 0 版)进行 ROM 严重程度分级,即无 ROM 组、轻中度组和重度组,比较不同 ROM 严重程度分级患者的营养指标和营 养干预方式。 结果 154 例患者放疗后体重、BMI、白蛋白和前白蛋白显著降低,而 NRS 2002 评分显著增加,差异有统计学意义 (P<0. 05)。 放疗后无 ROM 组 41 例、轻中度组 91 例和重度组 22 例,三组放疗前各营养指标比较无明显差异(P>0. 05),放疗后 重度组体重、BMI、血红蛋白、白蛋白和前白蛋白显著低于轻中度组,各指标减少量显著高于轻中度组,NRS 2002 评分以及增加量 显著大于轻中度组(P<0. 05);轻中度组与无 ROM 组之间也有显著差异(P<0. 05)。 重度组肠内营养显著多于轻中度组,肠外营 养供给时间显著延长,营养供应总能量显著增加;轻中度组与无 ROM 组之间也有显著差异(P<0. 05)。 结论 MRT 的鼻咽癌患者 ROM 的发生与营养状况密切相关,可相互影响、相互作用;提高放疗技术,降低 ROM 发生风险是改善营养状况的重要方法。

Objective To evaluate the correlation between nutritional status and radiation – induced oral mucositis ROM in nasopharyngeal carcinoma NPC patients during radiotherapy so as to provide a reference for clinical improvement of radiotherapy effect reduction of radiotherapy complication and improvement of nutrition supply. Method A total of 154 patients with NPC diagnosis for the first time into our hospital from May 2020 to May 2022 were enrolled retrospectively. They received intensity modulated radiation therapy IMRT or chemoradiotherapy for at least 4 weeks. Compare the nutritional indicators before and 4 weeks after radiotherapy including body weight body mass index BMI hemoglobin albumin and prealbumin levels and the nutritional risk screening score 2002 NRS 2002 score. After radiotherapy grade of ROM severity according to the American Common Adverse Reaction Terminology Assessment Standard CTCAE Version 5. 0 that is no mild to moderate and severe groups. Compare the nutritional indicators and nutritional intervention methods during the ROM groups. Result The body weight BMI albumin and prealbumin of 154 patients decreased significantly after radiotherapy while the NRS 2002 score increased significantly P< 0. 05 . After radiotherapy there were 41 cases in the non ROM group 91 cases in the mild to moderate group and 22 cases in the severe group. There were no differences among the three groups of all the nutritional indicators before radiotherapy P > 0. 05 . After radiotherapy the weight BMI hemoglobin albumin and prealbumin in the severe group were significantly lower than those in the mild to moderate group and the reduction of each indicator was significantly higher than that in the mild to moderate group the NRS 2002 score and increasement were significantly higher than those in the mild to moderate group too P<0. 05 there were also differences between the mild to moderate group and the non ROM group P<0. 05 . In severe group enteral nutrition was significantly more than that in mild to moderate group the time of parenteral nutrition supply was significantly longer and the total energy of nutrition supply was significantly higher there were also differences between the mild to moderate group and the non ROM group too P<0. 05 . Conclusion ROM occurrence is closely related to nutritional status which can influence and interact with each other in NPC patients during IMRT improving radiotherapy technology and reducing the risk of ROM are important method to improve nutritional status.