目的 调查头颈部肿瘤患者放射治疗(简称放疗)期间严重体重丢失的变化趋势并分析其影响因素。 方法 采用回 顾性队列研究设计,便利选择 2021 年 9 月至 2023 年 10 月在中南大学湘雅医院接受放疗的头颈部肿瘤患者作为研究对象。 使用自行编制的资料收集工具在放疗前(T0 )、放疗开始后第 1 周(T1 )、第 2 周(T2 )、第 3 周(T3 )、第 4 周(T4 )、第 5 周(T5 )和 第 6 周(T6 )收集研究对象的相关信息。 使用广义估计方程分析严重体重丢失轨迹的影响因素。 结果 本研究共纳入 575 例头 颈部肿瘤患者,严重体重丢失在 T1 、T2 、T3 、T4 、T5 和 T6 的发生率分别为 1. 22%、6. 43%、14. 61%、24. 87%、37. 39%和 52. 52%。 广义估计方程分析结果显示,临床分期(以Ⅰ期作为参照,ORⅡ期 = 3. 685、ORⅢ期 = 3. 520、ORⅣ期 = 3. 792)、基线 BMI(以 BMI< 18. 5 kg / m 2 作为参照,OR24. 0~ 28. 0 kg / m 2 = 2. 832、OR≥28. 0 kg / m 2 = 3. 481)和白蛋白(OR = 0. 943)是头颈部肿瘤患者放疗期间严重体 重丢失轨迹的影响因素(P<0. 05)。 结论 头颈部肿瘤患者严重体重丢失发生率随放疗周期延长呈上升趋势,医护人员应动态监测头 颈部肿瘤患者放疗期间的体重变化,针对晚期、高 BMI 和低白蛋白患者,优先开展多层次的营养管理,以降低营养不良发生率。

Objective To investigate the trend of critical weight loss during radiotherapy in head and neck cancer patients and to analyze its influencing factors. Method A historical cohort study design was used. Head and neck cancer patients treated with radiotherapy in Xiangya Hospital Central South University were enrolled for the research from September 2021 to October 2023. A self-developed data collection tool was used to collect information about the study subjects before radiotherapy T0 at week 1 T1 week 2 T2 week 3 T3 week 4 T4 week 5 T5 and week 6 T6 after the start of radiotherapy. Factors influencing the trajectory of critical weight loss were analyzed using generalized estimated equation. Result A total of 575 head and neck cancer patients were included in this study and the incidence of critical weight loss was 1. 22% 6. 43% 14. 61% 24. 87% 37. 39% and 52. 52% at T1 T2 T3 T4 T5 and T6 respectively. The generalized estimated equation analysis revealed that clinical stage with stageⅠ as reference ORⅡ = 3. 685、 ORⅢ = 3. 520、 ORⅣ = 3. 792 baseline BMI with BMI < 18. 5 kg / m 2 as reference OR24. 0~ 28. 0 kg / m 2 = 2. 832、OR≥28. 0 kg / m 2 = 3. 481 and albumin level OR = 0. 943 were significant predictors P< 0. 05 for critical weight loss trajectories during radiotherapy in head and neck cancer patients. Conclusion The incidence of critical weight loss in head and neck cancer patients is on the rise with the prolongation of radiotherapy cycles. Healthcare professionals should dynamically monitor weight changes in head and neck cancer patients during radiotherapy with prioritized implementation of multi - level nutritional interventions for patients with advanced-stage disease high BMI or low albumin levels to reduce the incidence of malnutrition.