目的 基于能力、机会、动机-行为(COM-B)模型分析宫颈癌患者放射治疗前后膳食结构变化特点,并探究影响营 养状态的因素。 方法 纳入 2023 年 1 月至 2024 年 12 月在蚌埠医科大学第一附属医院收治的 200 例宫颈癌患者,调查放射治 疗前后膳食结构变化特点,根据控制营养状态评分(CONUT)将患者分为营养正常组(n = 114)和营养异常组( n = 86),分析两 组临床资料差异,并基于 COM-B 模型分析营养状态的影响因素。 结果 宫颈癌患者中国膳食宝塔评分放射治疗前为(31. 54± 4. 57)分,放射治疗后为(22. 24±2. 68)分,放射治疗后膳食结构显著恶化。 多因素 Logistic 回归方程结果显示,营养知识(OR= 0. 930,95%CI = 0. 901~ 0. 959)、自我管理(OR= 0. 952,95%CI = 0. 915~ 0. 990)、支付方式(OR= 3. 251,95%CI = 1. 372 ~ 7. 704)、 家庭月收入(OR= 4. 195,95% CI = 1. 637 ~ 10. 746)、社会支持(OR = 0. 689,95% CI = 0. 602 ~ 0. 788)、应对方式(OR = 2. 677, 95%CI = 1. 112~ 6. 443)、自我效能(OR= 0. 963,95%CI = 0. 931~ 0. 996)是营养状态的影响因素(P<0. 05)。 联合指标预测营养 状态的曲线下面积(AUC)为 0. 926,敏感度和特异度分别为 89. 50%、86. 80%。 结论 宫颈癌患者饮食结构不合理,临床可基于 COM-B 模型进行膳食结构干预,改善患者营养状况。

Objective Based on the capability opportunity motivation - behavior COM-B model this study aimed to analyze changes in dietary structure characteristics among patients with cervical cancer before and after radiotherapy and explore factors influencing their nutritional status. Method A total of 200 patients with cervical cancer admitted to the First Affiliated Hospital of Bengbu Medical University between January 2023 and December 2024 were enrolled. Changes in dietary structure before and after radiotherapy were investigated. Patients were divided into a normal nutritional status group n = 114 and an abnormal nutritional status group n = 86 based on the controlling nutritional status CONUT score. Differences in clinical data between the two groups were analyzed and factors influencing nutritional status were explored using the COM - B model. Result The Chinese Dietary Pyramid CHFP score of patients with cervical cancer was 31. 54 ± 4. 57 before radiotherapy and 22. 24 ± 2. 68 after radiotherapy indicating a significant deterioration in dietary structure post - radiotherapy. Multivariate Logistic regression analysis revealed that nutritional knowledge OR= 0. 930 95%CI = 0. 901-0. 959 self-management OR= 0. 952 95%CI = 0. 915-0. 990 payment method OR= 3. 251 95% CI = 1. 372 - 7. 704 monthly household income OR = 4. 195 95% CI = 1. 637 - 10. 746 social support OR = 0. 689 95%CI = 0. 602 - 0. 788 coping style OR = 2. 677 95% CI = 1. 112 - 6. 443 and self - efficacy OR = 0. 963 95% CI = 0. 931-0. 996 were significant influencing factors of nutritional status all P< 0. 05 . The combined indicators showed an AUC of 0. 926 for predicting nutritional status with a sensitivity of 89. 50% and specificity of 86. 80%. Conclusion The dietary structure of patients with cervical cancer is unreasonable. Clinically dietary interventions based on the COM-B model may be implemented to improve their nutritional status.