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目的 观察放疗前不同营养状况及炎症反应指标对食管癌IMRT同期化疗患者急性相关不良反应的影响.方法 分析2006-2014年间在本院接受IMRT同步化疗并符合入组条件的338例食管癌患者的急性不良反应发生情况,观察治疗前不同营养状况[如体质量指数(BMI)、白蛋白(ALB)、总淋巴细胞计数(TLC)、有无贫血]以及不同炎症反应指标[如中性粒细胞淋巴细胞比值(NLR)、血小板淋巴细胞比值(PLR)]对其影响.采用连续性校正的χ2检验和Logistic回归分析.结果 338例患者以不同营养状况评价指标评价的营养不良发生率为5.62%~54.14%.营养状况指标中≥2级急性RE发生率低ALB组高于正常组(P=0.000);随着TLC的下降血液系统不良反应发生率增加(P=0.006),而RP发生率随着TLC的下降而降低(P=0.001);贫血组≥2级急性RE发生率高于非贫血组(P=0.000).炎症指标结果分析显示高NLR、高PLR组RE发生率显著高于低NLR组、低PLR组(P=0.000、0.024).将上述营养状况和炎症指标纳入Logistic回归分析发现TLC是急性血液系统不良反应的影响因素(P=0.001),ALB、PLR是急性RE的影响因素(P=0.017、P=0.011).结论 食管癌患者营养状况及炎症指标与放化疗相关急性不良反应有一定相关性,在临床应用中可能具有一定程度提示价值,临床工作中应予以重视并进行积极营养支持治疗.

Objective To examine the effects of different pre-treatment nutritional status and inflammatory markers on acute adverse reactions in esophageal cancer patients during concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy.Methods The acute adverse reactions of 338 eligible esophageal cancer patients who received concurrent IMRT and chemotherapy in our hospital from 2006 to 2014 were reviewed.The effects of different pre-treatment nutritional status, such as body mass index level (BMI), albumin level (ALB), total lymphocyte count (TLC), the presence or absence of anemia, and inflammatory indicators including neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), on acute adverse reactions in the patients were examined.Data were analyzed using the chi-square test with continuity correction and logistic regression analysis.Results The incidence rate of malnutrition in the patients based on their nutritional status was 5.62%-54.14%.The incidence rate of grade≥2 acute radiation esophagitis (RE) was significantly higher in the low ALB group than in the normal ALB group (P=0.000).The incidence rate of adverse reactions in the hematologic system increased as TLC decreased (P=0.006), but the incidence rate of acute radiation pneumonitis (RP) was reduced as TLC decreased (P=0.001).In addition, the incidence rate of grade ≥2 acute RE was significantly higher in the anemia group than in the non-anemia group.Inflammatory marker analysis demonstrated that the incidence rate of acute RE was significantly higher in the high NLR group and high PLR group than in the low NLR group and low PLR group (P=0.000 and P=0.024, respectively).Logistic regression analysis of nutritional status and inflammatory markers showed that TLC was an independent risk factor for acute adverse reactions in the hematologic system (P=0.001), and ALB and PLR were independent risk factors for acute RE (P=0.017 and P=0.011,respectively).Conclusions Nutritional status and inflammatory markers are associated with concurrent chemoradiotherapy-induced acute adverse reactions in esophageal carcinoma patients, and hence may be valuable indicators of acute adverse reactions during treatment.In addition, nutritional treatment and support care should be actively provided to the patients to prevent the development of acute adverse reactions during treatment.