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目的利用营养风险筛查工具(NRS2002)对食管癌住院患者的营养风险进行评估,并分析营养不良情况对患者生活质量及预后的影响。方法前瞻性选取我院2017年10月～2019年10月收治的食管癌住院患者110例,治疗前经NRS2002分析营养风险,经主观整体营养评估法(PG-SGA)评估营养不良情况,分析营养不良的危险因素。根据PG-SGA评分将患者分成营养正常组、轻度营养不良组、中度营养不良组、重度营养不良组。经简明生活质量量表(SF-36)评估患者生活质量,随访12个月观察预后情况,比较四组SF-36评分与预后。结果 110例患者中,NRS2002分析提示有营养风险者78例,无营养风险者32例。PG-SGA评分提示营养正常37例,轻度营养不良28例,中度营养不良25例,重度营养不良20例。多因素Logistic回归分析显示,年龄≥60岁(95%CI：1.312-3.374,OR=2.104)、消化道症状数目＞2个(95%CI：1.052-6.701,OR=2.655)、吞咽障碍(95%CI：1.711-13.601,OR=4.824)、术前合并症(95%CI：1.274-10.406,OR=3.641)是食管癌住院患者营养不良的危险因素(P＜0.05)。轻、中、重度营养不良组的躯体疼痛、精力、躯体功能、情绪角色功能、心理健康、社会功能、总体健康评分较营养正常组降低,且中、重度营养不良组低于轻度营养不良组,重度营养不良组低于中度营养不良组(P＜0.05)。营养正常组生存率为94.59%,高于重度营养不良组的70.00%(P＜0.05)。营养正常组、轻度营养不良组、中度营养不良组的生存率比较无统计学差异(P＞0.05)。结论食管癌住院患者营养风险及营养不良发生率较高,其营养状态主要受患者年龄、消化道症状数目、吞咽障碍、术前合并症的影响,对患者生活质量和预后影响较大,营养评估有望成为预测食管癌住院患者生活质量及预后的指标。

英文摘要:

Objective The nutritional risk screening tool (NRS2002) was used to assess the nutritional risk of hospitalized patients with esophageal cancer, and to analyze the effect of malnutrition status on the quality of life and prognosis of patients. Methods A total of 110 hospitalized patients with esophageal cancer who were admitted to our hospital from October 2017 to October 2019 were prospectively selected. Before treatment, nutritional risk was analyzed by NRS2002, and malnutrition status was analyzed according to the patient-generated subjective global assessment (PG-SGA), and the risk factors of malnutrition were analyzed. According to the PG-SGA score, the patients were divided into normal nutrition group, mild malnutrition group, moderate malnutrition group, severe malnutrition group. The quality of life of the patients was assessed by the 36-item medical outcomes study short-form (SF-36), the prognosis was observed at 12 months after follow-up, and the SF-36 scores and prognosis of the four groups were compared. Results Among 110 patients, the NRS2002 scale indicated 78 patients with nutritional risk, and 32 patients without nutritional risk. The PG-SGA score indicated 37 cases of normal nutrition, 28 cases of mild malnutrition, 25 cases of moderate malnutrition, and 20 cases of severe malnutrition. Multivariate Logistic regression analysis showed that age ≥ 60 years old (95%CI: 1.312-3.374, OR=2.104), the number of digestive tract symptoms > 2 (95%CI: 1.052-6.701, OR=2.655), swallowing disorders (95%CI: 1.711-13.601, OR=4.824) and preoperative comorbidities (95% CI: 1.274-10.406, OR=3.641) were risk factors for malnutrition in patients with esophageal cancer (P<0.05). The physical pain, energy, physical function, emotional role function, mental health, social function and overall health scores of the mild, moderate and severe malnutrition groups were lower than those of the normal nutrition group, and the moderate and severe malnutrition groups were lower than the mild malnutrition group, and the severe malnutrition group was lower than the moderate malnutrition group (P<0.05). The survival rate of normal nutrition group was 94.59%, which was higher than 70.00% of severe malnutrition group (P<0.05). There was no significant difference in the survival rate among the normal nutrition group, mild malnutrition group and moderate malnutrition group (P>0.05). Conclusion Patients with esophageal cancer have a higher nutritional risk and incidence of malnutrition. Their nutritional status is mainly affected by the patient’s age, the number of digestive tract symptoms, swallowing disorders and preoperative comorbidities, which have a greater impact on the quality of life and prognosis of patients. Nutritional assessment is expected to become indexes to predict the quality of life and prognosis of patients with esophageal cancer.

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