头颈肿瘤放疗患者NRS指导营养干预的临床疗效研究

Clinical Efficacy Study of NRS‑Guided Nutritional Intervention in Patients with Head and Neck Tumors Undergoing Radiotherapy

摘要: 目的：探讨营养风险筛查2002 (NRS-2002)指导下的规范化营养干预对头颈部肿瘤放疗患者体重、血液营养及免疫指标、营养风险等级、日常生活活动能力及放疗相关并发症的影响。方法：回顾性选取2024年06月至2025年06月本院肿瘤科60例头颈部肿瘤放疗患者，按营养干预方式分为实验组(n = 37，NRS-2002指导下规范营养干预)与对照组(n = 23，常规饮食健康指导)。比较两组放疗前后体重、总白蛋白、白蛋白、血红蛋白、白细胞、中性粒细胞、淋巴细胞、NRS-2002评分、ADL评分，及放疗期间发烧、反应性皮炎发生率。结果：放疗前两组各项指标比较均无统计学差异(P > 0.05)；放疗后，实验组体重下降幅度(1.23 ± 1.67 kg)显著小于对照组(6.47 ± 2.47 kg) (t = 8.98, P < 0.001)；实验组总白蛋白、白蛋白、血红蛋白、白细胞、淋巴细胞降低幅度均显著小于对照组(P < 0.05)，中性粒细胞降低幅度两组无统计学差异(P > 0.05)；实验组NRS-2002评分升高幅度(0.87 ± 0.46)小于对照组(1.19 ± 0.57) (t = 2.27, P = 0.027)；实验组ADL评分(1.16 ± 0.37)显著低于对照组(1.83 ± 0.49)，ADL评分改善幅度(0.89 ± 0.31)显著大于对照组(−0.52 ± 0.79) (t = −8.18, P < 0.001)；实验组发烧发生率(21.62%)显著低于对照组(60.87%) (χ² = 9.41, P = 0.002)，反应性皮炎发生率两组无统计学差异(P = 0.435)。结论：NRS-2002指导下的规范化营养干预与头颈部肿瘤放疗患者体重丢失减少、营养状况及外周血指标改善相关，且与营养风险进展减缓(实验组NRS-2002评分升高幅度小于对照组)及日常生活活动能力改善相关，并可降低放疗相关发烧发生率；两组中性粒细胞降低幅度、反应性皮炎发生率均无显著差异。上述结果基于短期观察，该干预的长期效果尚不确定。

Abstract: Objective: To explore the effects of standardized nutritional intervention guided by Nutritional Risk Screening 2002 (NRS-2002) on body weight, hematological nutritional and immune parameters, nutritional risk grade, activities of daily living (ADL), and radiotherapy-related complications in patients with head and neck cancer undergoing radiotherapy. Methods: A total of 60 patients with head and neck cancer receiving radiotherapy admitted to the Department of Oncology of our hospital from June 2024 to June 2025 were retrospectively enrolled. According to different nutritional intervention protocols, the patients were divided into experimental group (37 cases, standardized nutritional intervention guided by NRS-2002) and control group (23 cases, routine dietary health guidance). Body weight, total protein, albumin, hemoglobin, white blood cells, neutrophils, lymphocytes, NRS-2002 score and ADL score before and after radiotherapy, as well as the incidence of fever and radiation dermatitis during radiotherapy were compared between the two groups. Results: There were no statistically significant differences in all indicators between the two groups before radiotherapy (P > 0.05). After radiotherapy, the weight loss in the experimental group (1.23 ± 1.67 kg) was significantly lower than that in the control group (6.47 ± 2.47 kg) (t = 8.98, P < 0.001). The decreasing ranges of total protein, albumin, hemoglobin, white blood cells and lymphocytes in the experimental group were significantly smaller than those in the control group (P < 0.05), while no significant difference was found in the decreasing range of neutrophils between the two groups (P > 0.05). The increased range of NRS-2002 score in the experimental group (0.87 ± 0.46) was lower than that in the control group (1.19 ± 0.57) (t = 2.27, P = 0.027). The post-radiotherapy ADL score of the experimental group (1.16 ± 0.37) was markedly lower than that of the control group (1.83 ± 0.49), and the improvement range of ADL score in the experimental group (0.89 ± 0.31) was superior to that in the control group (−0.52 ± 0.79) (t = −8.18, P < 0.001). The incidence of fever in the experimental group (21.62%) was significantly lower than that in the control group (60.87%) (χ² = 9.41, P = 0.002). There was no statistical difference in the incidence of radiation dermatitis between the two groups (P = 0.435). Conclusion: Standardized nutritional intervention based on NRS-2002 was associated with reduced body weight loss, improved nutritional status and peripheral blood related parameters, and attenuated progression of nutritional risk (the increased range of NRS-2002 score in the experimental group was lower than that in the control group) in patients with head and neck cancer undergoing radiotherapy; it was also associated with improved activities of daily living and a lower incidence of radiotherapy-related fever. No significant between-group differences were observed in the decreasing range of neutrophils or the incidence of radiation dermatitis. These findings are based on short-term observation, and the long-term effect of the intervention remains unclear.