目的 探讨基于肺癌症状群干预的营养支持方案对肺癌化疗患者耐受性、免疫功能及营养状况的影响。方法 收集2020年10月至2022年10月期间在康复大学青岛医院(青岛市市立医院)收治的77例肺癌化疗患者为对照组,对照组患者实施常规营养支持方案,同时选取2022年11月至2024年10月期间的76例肺癌患者作为观察组,观察组患者实施基于肺癌症状群干预的营养支持方案。比较两组患者化疗6个月后的中文版安德森症状评估量表(MDASI-C)评分、主观整体营养状况评定量表(PG-SGA)评分、转铁蛋白(TF)、白蛋白(ALB)、前白蛋白(PA)、臂肌围(MAMC)、三头肌皮褶厚度(TSF)、体质指数(BMI)及免疫功能指标(CD4+T淋巴细胞、CD3+T淋巴细胞、CD8+T淋巴细胞)。同时,统计化疗期间的不良反应发生率及化疗中断率。结果 干预6个月后,两组患者MDASI-C评分、PG-SGA评分均较干预前显著降低(P＜0.05),其中观察组症状对生活困扰评分下降至(3.68±1.43)分,癌症症状评估总分降至(51.14±6.53)分,改善幅度优于对照组(P＜0.001)。营养指标方面,观察组TF、ALB、PA水平分别升至(3.14±0.31)g/L、(41.16±3.15)g/L、(168.97±11.21)g/L,显著高于对照组(P＜0.001),而MAMC、TSF、BMI两组间差异无统计学意义(P＞0.05)。免疫指标显示,观察组CD4+、CD3+、CD8+T淋巴细胞百分比分别提升至(39.58±3.51)%、(67.84±4.13)%、(25.67±2.32)%,均显著高于对照组(P＜0.001)。不良反应方面,观察组总发生率为11.84%(9/76),显著低于对照组的27.27%(21/77,P=0.016),其中恶心呕吐、骨髓抑制等主要不良反应发生率均低于对照组(P＜0.05)。化疗耐受性方面,观察组中断率为3.95%(3/76),对照组为12.99%(10/77),差异具有统计学意义(P=0.045)。结论 基于肺癌症状群干预的营养支持方案能有效改善肺癌化疗患者营养状况,提高免疫功能,降低不良反应。
Abstract
Objective To explore the effects of a nutritional support program based on symptom cluster intervention on chemotherapy tolerance, immune function, and nutritional status in lung cancer patients. Method A cohort of 77 chemotherapy patients with lung cancer admitted to Qingdao Hospital (Qingdao Municipal Hospital) from October 2020 to October 2022 was designated as the control group, who received standard nutritional support. Meanwhile, 76 patients with lung cancer from November 2022 to October 2024 were selected as the observation group, who underwent symptom-based nutritional support interventions for lung cancer. The observation group (n=76) received nutritional support tailored to lung cancer symptom clusters, while the control group (n=77) received routine nutritional care. After 6 months of chemotherapy, between-group comparisons were conducted for the following outcomes. Symptom burden: Chinese version of the Anderson symptom assessment scale (MDASI-C) scores; nutritional status: subjective global nutritional assessment (PG-SGA) scores, transferrin (TF), albumin (ALB), prealbumin (PA), brachial muscle circumference (MAMC), triceps skinfold thickness (TSF), and body mass index (BMI);Immune function: percentages of CD4+, CD3+, and CD8+T lymphocytes; Safety outcomes: incidence of adverse reactions and chemotherapy interruption rate. Result Both groups showed significant reductions in MDASI-C and PG-SGA scores post-intervention (P<0.05). The observation group demonstrated greater improvements in symptom distress (3.68±1.43 points) and total cancer symptom scores (51.14±6.53 points) compared to the control group (P<0.001). Nutritional indicators (TF: 3.14±0.31 g/L; ALB: 41.16±3.15 g/L; PA: 168.97±11.21 g/L) were significantly higher in the observation group (P<0.001), whereas no between-group differences were observed for MAMC, TSF, or BMI (P>0.05). Immune markers [CD4+:(39.58±3.51)%; CD3+:(67.84±4.13)%; CD8+:(25.67±2.32)%] were also superior in the observation group (P<0.001). The observation group had a lower incidence of adverse reactions (11.84% vs. 27.27%, P=0.016), including nausea, vomiting, and bone marrow suppression (P<0.05), and a reduced chemotherapy interruption rate (3.95% vs. 12.99%, P=0.045). Conclusion The symptom cluster-based nutritional program effectively improves nutritional status, enhances immune function, reduces adverse reactions, and increases chemotherapy tolerance in lung cancer patients, supporting its clinical application.
关键词
肺癌症状群 /
营养支持方案 /
肺癌 /
化疗 /
耐受性 /
免疫功能 /
营养状况 /
不良反应
Key words
Lung cancer symptom cluster /
Nutritional support program /
Lung cancer /
Chemotherapy /
Tolerance /
Immune function /
Nutritional status /
Adverse reactions
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