肿瘤患者营养状况调查及其影响因素分析

发布时间：2018-11-22 09:08

【摘要】：背景近年来,恶性肿瘤患者的发病率处于上升趋势,恶性肿瘤患者营养不良高发。多数肿瘤患者死于营养不良而非肿瘤疾病本身,恶性肿瘤营养不良成为影响人类健康的重要疾病。全球每年有超过200万肿瘤患者死于严重的营养不良,因此本研究采用国内外较为常用的肿瘤患者营养不良评估方法-患者主观整体评估法(patient-generated subjective global assessment,PG-SGA),对肿瘤患者进行营养状况评估并分析影响肿瘤患者营养不良的因素,探索PG-SGA法的实用性和可行性,并为肿瘤患者的营养干预及支持提供依据。目的采用患者主观整体评估法(PG-SGA)对安徽省肿瘤医院放化疗科肿瘤患者进行营养评估,并分析影响肿瘤患者营养不良的多种因素。方法应用PG-SGA法对2014年2月1日至2016年8月31日在安徽省肿瘤医院放化疗科住院治疗的996例肿瘤患者,入院48h内完成营养评估。并将其分为营养状况良好(PG-SGA A级)、可疑或中度营养不良(PG-SGA B级)、重度营养不良(PG-SGA C级)三组;PG-SGA A级归为无营养不良组、PG-SGA B级与PG-SGA C级归为营养不良组,并收集患者基本信息及各项客观营养指标。分析各因素与营养不良的关系。结果1.本研究共纳入959例恶性肿瘤患者,PG-SGA A级366例(38.16%)、PG-SGA B级268例(27.95%)、PG-SGA C级325例(33.89%),营养不良发生率为61.84%。其中胃癌为83.22%,食管癌为78.53%,结直肠癌55.29%,宫颈癌为51.66%,肺癌营养不良发生率为51.11%,乳腺癌为40.30%。2.多因素Logistic回归分析结果显示:性别(OR=0.164)、年龄(OR=0.958)、体重指数(OR=11.769)、低蛋白血症(OR=10.982)、放疗(OR=1.629)、口干(OR=0.038)、早饱(OR=0.053)、非利手(或非损伤手)握力(OR=1.060)是恶性肿瘤发生营养不良的独立危险因素。结论1.PG-SGA法是一种可靠、适合临床广泛应用的恶性肿瘤患者营养状况评价工具;建议常规对入院的肿瘤患者进行PG-SGA评估,为临床治疗提供依据。2.营养不良在恶性肿瘤患者,特别是消化道肿瘤患者的发生率比较高,定期的对肿瘤患者进行营养评估,及时予以营养干预及支持,是十分必要的。3.恶性肿瘤患者发生营养不良的影响因素复杂多样,应关注营养不良的危险因素,早日实现肿瘤患者个体化、规范化的营养干预与支持治疗;由于营养不良的发生机制尚未完全明确,未来我们需要继续深入探索。
[Abstract]:Background in recent years, the incidence of malignant tumor patients is on the rise, high incidence of malnutrition in patients with malignant tumors. Most cancer patients die of malnutrition rather than tumor disease itself, and malignant tumor malnutrition has become an important disease affecting human health. More than 2 million cancer patients die from severe malnutrition every year in the world. Therefore, this study adopts the domestic and foreign more commonly used methods for the evaluation of malnutrition in cancer patients-patient subjective global assessment (patient-generated subjective global assessment,PG-SGA). The nutritional status of tumor patients was evaluated and the factors affecting malnutrition were analyzed to explore the practicability and feasibility of PG-SGA method and to provide evidence for nutritional intervention and support of tumor patients. Objective to evaluate the nutritional status of tumor patients in the department of radiotherapy and chemotherapy in Anhui Cancer Hospital by using subjective holistic assessment (PG-SGA), and to analyze the factors affecting malnutrition in tumor patients. Methods from February 1, 2014 to August 31, 2016, a total of 996 patients with cancer were enrolled in the department of radiotherapy and chemotherapy in Anhui Cancer Hospital. The nutritional evaluation was completed within 48 hours of admission. They were divided into three groups: good nutritional status (PG-SGA A), suspected or moderate malnutrition (PG-SGA B) and severe malnutrition (PG-SGA C). PG-SGA A was classified as no malnutrition, PG-SGA B and PG-SGA C were classified as malnutrition, and basic information and objective nutritional indexes were collected. The relationship between various factors and malnutrition was analyzed. Result 1. A total of 959 patients with malignant tumors were included in this study. There were 366 cases (38.16%) with PG-SGA A grade, 268 cases (27.95%) with PG-SGA B grade and 325 cases (33.89%) with PG-SGA C grade. The incidence of malnutrition was 61.84%. Among them, 83.22 stomach cancer, 78.53 esophageal carcinoma, 55.29 colorectal cancer, 51.66 cervical cancer, 51.11 lung cancer malnutrition and 40.30 percent breast cancer. The results of multivariate Logistic regression analysis showed: sex (OR=0.164), age (OR=0.958), body mass index (OR=11.769), hypoproteinemia (OR=10.982), radiotherapy (OR=1.629), dry mouth (OR=0.038), early satiety (OR=0.053). Hand-free (or non-invasive) grip strength (OR=1.060) is an independent risk factor for malnutrition in malignant tumors. Conclusion 1.PG-SGA method is a reliable and suitable tool for evaluating the nutritional status of patients with malignant tumor, and it is suggested that routine evaluation of PG-SGA should be carried out to provide the basis for clinical treatment. 2. The incidence of malnutrition in patients with malignant tumor, especially in patients with digestive tract tumor is relatively high. It is very necessary to evaluate the nutrition of cancer patients regularly and give nutrition intervention and support in time. The influencing factors of malnutrition in patients with malignant tumor are complex and diverse, so we should pay attention to the risk factors of malnutrition, realize individualization of tumor patients as soon as possible, and standardize nutritional intervention and support therapy. As the mechanism of malnutrition is not yet fully understood, we need to explore further in the future.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5

【参考文献】