血液系统恶性肿瘤老年患者化疗期间营养不良情况及重度营养不良的影响因素^*

Risk of malnutrition and influencing factors of severe malnutrition during chemotherapy in elderly patients with hematological malignancies

摘要

目的 评估血液系统恶性肿瘤老年患者化疗期间的营养状况, 分析发生重度营养不良的相关危险因素。方法 选择2022年9月—2024年4月南京医科大学第一附属医院住院治疗的260例血液系统恶性肿瘤化疗老年患者为研究对象。采用肿瘤患者主观整体评估法进行营养状况评估, 并根据评分标准将患者分为可疑或中度营养不良组、重度营养不良组。采用方差分析、t检验或秩和检验对不同组间的差异进行分析, 采用多因素logistic回归模型分析重度营养不良的相关危险因素。结果 可疑或中度营养不良组152例(59.62%), 重度营养不良组108例(40.38%), 两组性别、年龄、体质量指数、疾病类型、焦虑情况、慢性疾病史比较, 差异均有统计学意义(P<0.05)。重度营养不良组的白蛋白、血红蛋白水平低于与可疑或中度营养不良组(P<0.05); 重度营养不良组骨髓抑制程度高的比例偏多, 两组骨髓抑制程度比较, 差异有统计学意义(P<0.05)。重度营养不良组出现恶心呕吐、腹泻、便秘、腹胀和口腔黏膜炎的比例高于可疑或中度营养不良组(P<0.05); 两组食欲减退比较, 差异无统计学意义(P>0.05)。多因素logistic回归模型分析显示: 女性、年龄≥70岁、焦虑、恶心呕吐、腹泻、便秘、腹胀及口腔黏膜炎为血液系统恶性肿瘤老年患者化疗期间出现重度营养不良的独立危险因素(P<0.05); 另外, 淋巴细胞恶性肿瘤老年患者发生重度营养不良的风险较髓细胞恶性肿瘤患者低(P<0.05)。结论 血液系统恶性肿瘤老年患者化疗期间重度营养不良发生率高, 性别、年龄、焦虑、恶心呕吐、腹泻、便秘、腹胀及口腔黏膜炎等均对其产生不同程度的影响, 积极采取针对性措施改善患者营养状况并为患者提供适当的营养教育和营养支持, 降低重度营养不良发生率。

Abstract

Objective To evaluate the nutritional status of elderly patients with hematological malignancies during chemotherapy and compare the risk factors of severe malnutrition. Methods The relevant clinical data of 260 elderly patients with hematological malignancy undergoing chemotherapy from September 2022 to April 2024 was selected. The patient-generated subjective global assessment method was used to evaluate the patients' nutritional status, and based on the results, the patients were categorized into two groups: those with suspected or moderate malnutrition, and those with severe malnutrition. To compare the differences of pertinent factors between groups, analysis of variance, t test, or rank sum test were employed. Logistic regression was utilized to examine the associated risk factors for severe malnutrition. Results There were 152 cases (59.62%) in the suspected or moderate malnutrition group, and 108 cases (40.38%) in the severe malnutrition group. There were statistically significant differences in gender, age, body mass index, disease type, anxiety status and history of chronic diseases between the two groups (P<0.05). The levels of albumin and hemoglobin in the severe malnutrition group were lower than those in the suspected or moderate malnutrition group (P<0.05). The proportion of people with a high degree of bone marrow suppression in the severe malnutrition group was higher (P<0.05). The proportions of nausea, vomiting, diarrhea, constipation, abdominal distension and oral mucositis in the severe malnutrition group were higher than those in the suspected or moderate malnutrition group (P<0.05). There was no statistically significant difference in appetite loss between the two groups (P>0.05). A logistic multivariate analysis revealed that among patients with hematologic malignancies, female, age greater than or equal to 70 years old, nausea and vomiting, diarrhea, constipation, ventosity, oral mucositis were risk factors for severe malnutrition during chemotherapy in elderly patients with hematological malignancies (P<0.05), and elderly patients with lymphocytic malignancies have a lower risk of severe malnutrition than myeloid malignancies patients (P<0.05). Conclusion The incidence of severe malnutrition in elderly patients with hematologic malignancies during chemotherapy is high, and gender, age, anxiety, nausea and vomiting, diarrhea, constipation, ventosity, oral mucositis all have varying degrees of influence on them. Relevant measures are actively taken to improve the nutritional status of patients and provide appropriate nutrition education and nutrition support for patients and their families, to reduce the incidence of severe malnutrition.

关键词

血液系统恶性肿瘤 / 化疗 / 营养不良 / 影响因素

Key words

Hematological malignancy / Chemotherapy / Malnutrition / Risk factor

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基金资助

^*国家自然科学基金(82200209)