多学科营养管理可改善接受放化疗食管癌患者的营养和住院结局：一项随机对照试验。

Multidisciplinary nutritional management improves nutritional and hospitalized outcomes of patients with esophageal cancer undergoing chemoradiotherapy: A randomized control trial.

机构信息

Department of Clinic Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.

The Cadre Health Care Ward, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.

出版信息

Medicine (Baltimore). 2023 Mar 24;102(12):e33335. doi: 10.1097/MD.0000000000033335.

DOI:10.1097/MD.0000000000033335

PMID:36961192

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10036000/

Abstract

BACKGROUND

This study aimed to investigate the effects of multidisciplinary whole-course nutrition management on the nutritional status and complications during the course of treatment in patients with esophageal cancer (EC) undergoing chemoradiotherapy.

METHODS

A total of 36 EC patients undergoing chemoradiotherapy were divided into a control group (n = 18) and an intervention group (n = 18). Participants in the control group were given routine nutritional support, whereas those in the intervention group were provided whole-course nutrition management from the nutrition support team. Nutrition-related indicators, that is, serum albumin level (ALB), hemoglobin (Hb), and C reactive protein were assessed before, during, and after treatment in both groups. The incidence of complications (e.g., lymphocytopenia, radiation esophagitis, and myelosuppression), clinical outcomes, length of hospital stay, and hospital costs were also recorded. Differences between the 2 groups were tested using the Mann-Whitney U and chi-square tests.

RESULTS

The ALB and Hb levels of the patients in the control group decreased significantly [ALB: -2.6 (-5.6, 0), P = .01; Hb: -12.0 (-27.0, -2.0), P = .04] and C reactive protein increased [8.9 (2.9, 14.9), P = .02] compared to those before treatment, while the indicators of participants in the intervention group did not change (P > .05). The incidence of grade ≥ II lymphocytopenia was higher in the control group than that in the intervention group (33.3% vs 61.1%, P = .03). Moreover, compared with the control group, the average length of hospital stay decreased by 12 days [47 (40, 50) vs 35 (23, 40), P = .001], and in-patient expenses decreased by 20,504 CNY in the intervention group (P = .004).

CONCLUSION

Multidisciplinary whole-course nutrition management can maintain the nutritional status of patients with EC undergoing chemoradiotherapy. This may lower the incidence of complications, shorten hospital stays, and reduce in-patient expenses.

摘要

背景

本研究旨在探讨多学科全程营养管理对接受放化疗的食管癌（EC）患者治疗过程中营养状况和并发症的影响。

方法

共纳入 36 例接受放化疗的 EC 患者，分为对照组（n=18）和干预组（n=18）。对照组给予常规营养支持，干预组则由营养支持团队提供全程营养管理。评估两组患者治疗前后的营养相关指标，即血清白蛋白（ALB）水平、血红蛋白（Hb）和 C 反应蛋白（CRP）。记录并发症（如淋巴细胞减少症、放射性食管炎和骨髓抑制）的发生率、临床结局、住院时间和住院费用。采用 Mann-Whitney U 检验和卡方检验比较两组间的差异。

结果

对照组患者的 ALB 和 Hb 水平明显下降[ALB：-2.6（-5.6，0），P=0.01；Hb：-12.0（-27.0，-2.0），P=0.04]，CRP 升高[8.9（2.9，14.9），P=0.02]，而干预组患者的指标无变化（P＞0.05）。对照组患者的 II 级以上淋巴细胞减少症发生率高于干预组（33.3% vs 61.1%，P=0.03）。此外，与对照组相比，干预组的平均住院时间缩短了 12 天[47（40，50） vs 35（23，40），P=0.001]，住院费用减少了 20504 元（P=0.004）。