目的 探索头颈部肿瘤放射治疗(简称放疗)患者营养指数变化轨迹并分析不同轨迹的影响因素。方法 选取2023年1月至2024年9月江苏省人民医院收治的163例头颈部肿瘤放疗患者作为研究对象,采用基本信息调查问卷、预后营养指数及生存质量问卷进行调查。采用潜类别增长模型及多因素Logistic回归分析头颈部肿瘤放疗患者营养指数变化轨迹。结果 头颈部肿瘤患者放疗期间预后营养指数存在3条不同轨迹,平均概率分别为0.953、0.952,0.964。3条轨迹类别分别为营养不良加重组(58.8%)、营养状况平稳组(26.5%)、营养不良改善组(14.7%)。不同轨迹类别在年龄(χ2=12.630,P=0.002)、婚姻状况(χ2=7.113,P=0.029)、体质指数(BMI)(χ2=23.050,P＜0.001)、肿瘤分期(χ2=15.310,P=0.004)方面差异显著。多因素Logistic回归分析显示,年龄＞60岁(OR=1.124),肿瘤分期(Ⅱ期OR=2.542,Ⅲ期OR=3.497)成为营养指数轨迹的危险性因素(均P＜0.05),婚姻状况(有配偶OR=0.702)、BMI(>18.5 kg/m2 OR=0.881,>24 kg/m2 OR=0.560)成为营养指数轨迹的保护性因素(均P＜0.05)。生存质量差异分析结果显示:营养不良加重组患者的生活质量水平显著低于营养状况平稳组(P＜0.01)、低于营养状况改善组(P＜0.01),营养状况改善组患者的生活质量水平低于营养状况平稳组(P＜0.01)。结论 临床工作人员应密切关注营养不良加重组的头颈部肿瘤患者,制订个性化的营养干预方案,提供积极的、有针对性的营养支持,提高患者的预后生存质量。
Abstract
Objective To explore the trajectory of nutritional index changes in patients with head and neck cancer and to analyze their influencing factors. Method A total of 163 patients treated with radiotherapy for head and neck cancer in Jiangsu Provincial People's Hospital from January 2023 to September 2024 were selected as the study objects. A basic information questionnaire, prognostic nutrition index, and quality of life questionnaire were used for investigation. The latent class growth model and influencing factors were used to analyze the data. Results Three latent classes of nutritional index curve trajectories of head and neck cancer patients were identified, with mean probabilities of 0.953, 0.952, and 0.964, respectively. The three classes were the malnutrition - exacerbated group (58.8%), the stable nutritional status group (26.5%), and the malnutrition - improvement group (14.7%), respectively. There were significant differences in different trajectory classes in terms of age (χ2 = 12.630, P = 0.002), marital status (χ2 = 7.113, P = 0.029), BMI index (χ2 = 23.050, P < 0.001), and tumor stage (χ2 = 15.310, P = 0.004). Logistic regression analysis showed thatage > 60 years(OR=1.124),tumor stage(stage ⅡOR=2.542,stage ⅢOR=3.497) were the risk factors of the nutrition index trajectory (all P < 0.05), marriage status(with a spouse OR=0.702)and BMI(>18.5 kg/m2 OR=0.881,>24 kg/m2 OR=0.560) were the protective factors of the nutrition index trajectory (all P < 0.05). The difference analysis results of quality of life showed that the quality of life of patients in the malnutrition - exacerbated group was significantly lower than that of the stable nutrition group (P < 0.01) and that of the improved nutrition group (P < 0.01), and the quality of life of the improved nutrition group was lower than that of the stable nutrition group (P < 0.01). Conclusion In this study, by investigating the characteristics of changes in nutritional indices during radiotherapy in patients with head and neck cancer, three types of prognostic nutritional index trajectory types were identified. The different trajectories were affected by a combination of factors such as patients' own age, marital status, BMI, and tumor stage. Clinical staff should pay close attention to patients with head and neck cancer in the malnutrition - exacerbated group, formulate a personalized nutritional intervention plan, and provide active and targeted nutritional support to improve the quality of patients' prognosis and survival.
关键词
头颈癌 /
放疗 /
营养指数 /
轨迹 /
纵向研究 /
影响因素 /
风险因素 /
营养状况
Key words
Head and neck cancer /
Radiotherapy /
Nutritional index /
Trajectory /
longitudinal study /
Influencing factors /
Risk factors /
Nutritional status
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