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目的 探究生物电阻抗分析和营养相关实验室指标检测在头颈癌术前患者营养风险筛查中的作用.方法 方便抽样法抽取131例头颈癌住院患者,使用营养风险筛查2002 (NRS2002)量表筛查患者术前营养风险情况,同时使用人体成分分析仪采集生物电阻抗指标和通过电子病历采集营养相关的实验室检查指标.结果 头颈癌患者术前营养风险发生率为16.8% (22/131).相关分析显示,营养相关实验室检测指标与营养风险无关,而生物电阻抗指标中的去脂体质量、骨骼肌量、体质量指数(BMI)、无机盐量、水分量和蛋白质量与NRS2002筛查结果具有显著相关性(r=-0.228～-0.183,P＜0.05或0.01).单因素分析显示,BMI、去脂体质量、蛋白质量、骨骼肌量、水分量、咽癌、淋巴转移和合并糖尿病是存在营养风险的影响因素(t=-4.121～2.918,χ2=4.167、6.353、4.032,P＜0.01或0.05),多因素分析显示,淋巴转移是营养风险的独立危险因素.结论 头颈癌术前患者需进行营养风险筛查,尤其是肿瘤位于咽部、存在淋巴转移和合并糖尿病的患者.生物电阻抗分析可作为头颈癌术前患者营养风险筛查参考之一,可为存在营养风险的患者提供关于人体成分的具体问题,从而为营养风险干预提供明确的方向且可作为干预效果的评估方式,建议其可作为营养风险筛查的辅助工具.

Objective To explore the role of bioelectrical impedance analysis (BIA) and laboratory tests for nutrition related indicators in preoperative nutritional risk screening of patients with head and neck cancer. Methods Totally 131 patients with head and neck cancer were selected by convenient sampling method. The nutritional risk was screened by NRS 2002 nutritional risk screening scale. The bioelectrical impedance indexes were collected by human body component analysis instrument and the nutritional related laboratory indicators were collected by electronic medical records. Results The incidence of nutritional risk in patients with head and neck cancer before operation was 18.6% (22/131). Correlation analysis showed that nutrition-related laboratory indicators were not related to nutritional risk, while bioelectrical impedance indicators such as fat-free mass, skeletal muscle mass, bodi mass index (BMI), inorganic salt content, water content and protein content were significantly correlated with NRS 2002 screening results(r=-0.228--0.183,P＜0.05 or 0.01). Univariate analysis showed that BMI, fat-free mass, protein content, skeletal muscle mass, water content, pharyngeal cancer, lymphatic metastasis, and diabetes mellitus were risk factors for nutritional risk (t=-4.121-2.918, χ2=4.167, 6.353, 4.032,P＜0.01 or 0.05). Multivariate analysis showed that lymphatic metastasis was the independent risk factors of nutritional risk. Conclusions Preoperative nutritional risk screening is required for patients with head and neck cancer, especially those with tumor located in the pharynx, lymphatic metastasis and diabetes mellitus. Bioelectrical impedance analysis can be used as a reference for preoperative nutritional risk screening of patients with head and neck cancer, and can provide specific questions about human body composition for patients with nutritional risk, so as to provide a clear direction for nutritional risk intervention and can be used as an evaluation method of intervention. It is recommended that bioelectrical impedance analysis can be used as an auxiliary tool for nutritional risk screening.