广西医学

目的观察鼻咽癌患者放化疗期间骨骼肌质量的纵向变化及影响因素。方法选取接受同步放化疗的192例鼻咽癌患者作为研究对象。于放疗前1 d、放疗中期、最后一次放疗结束时，测量患者的人体测量学指标［骨骼肌质量指数（SMI）、体质指数、小腿围］，采用营养风险筛查2002（NRS2002）量表、头颈患者症状检查表评估患者的营养风险、营养影响症状（NIS）强度及每个NIS干扰饮食强度。采用广义估计方程分析该患者治疗期间骨骼肌质量的影响因素。结果随着治疗时间的延长，鼻咽癌患者的SMI、体质指数、小腿围总体呈下降趋势，而NRS2002量表总分、NIS强度得分、NIS干扰饮食强度得分总体呈增加趋势（P<0.05）。鼻咽癌患者的骨骼肌质量下降发生率从治疗前的26.04%（50/192）上升到治疗结束时的62.50%（120/192）。广义估计方程分析结果显示，治疗阶段、性别、病程、小腿围、体质指数、NRS2002量表总分和NIS干扰饮食强度得分是鼻咽癌患者SMI的影响因素（P<0.05）。结论鼻咽癌患者骨骼肌质量随着放化疗时间的延长而呈下降趋势，医护人员应重视鼻咽癌患者放化疗期间骨骼肌质量的动态综合评估，重点关注男性、NIS干扰饮食强度大、营养风险高的患者，可通过持续监测小腿围、体质指数以评估患者骨骼肌质量丢失的风险。

Objective To observe the longitudinal changes and influencing factors of skeletal muscle mass in patients with nasopharyngeal carcinoma during chemoradiotherapy. Methods A total of 192 patients with nasopharyngeal carcinoma receiving concurrent chemoradiotherapy were selected as the research subjects. The anthropometric indices (skeletal muscle mass index ［SMI］, body mass index, calf circumference) were measured before 1 day of radiotherapy, at mid⁃radiotherapy, and at the end of the last radiotherapy. The Nutritional Risk Screening 2002 (NRS2002) scale, Head and Neck Patient Symptom Checklist were used to evaluate patients' nutritional risk, nutrition impact symptom (NIS) intensity, and intensity of diet interference by each NIS. The influencing factors for skeletal muscle mass of patients during treatment were analyzed by using the generalized estimating equations. Results With the prolonging of treatment time, SMI, body mass index, and calf circumference of patients with nasopharyngeal carcinoma exhibited an overall downward trend, while the total score of NRS2002 scale, NIS intensity score and NIS diet interference intensity score expressed an overall increasing trend (P<0.05). The incidence rate of skeletal muscle mass loss in patients with nasopharyngeal carcinoma increased from 26.04% (50/192) before treatment to 62.50% (120/192) after the end of treatment. The results of generalized estimating equations revealed that treatment stage, gender, disease course, calf circumference, body mass index, total score of NRS2002 scale, and score of NIS diet interference intensity were the influencing factors for SMI in patients with nasopharyngeal carcinoma (P<0.05). Conclusions Skeletal muscle mass of patients with nasopharyngeal carcinoma exhibits a downward trend with the prolonging of the time of chemoradiotherapy. Medical and nursing staff should pay attention to dynamic and comprehensive evaluation of skeletal muscle mass of patients with nasopharyngeal carcinoma during chemoradiotherapy, and pay attention to male patients, patients with high NIS diet interference intensity, and high nutritional risk. Continuous monitoring of calf circumference and body mass index can be used to evaluate the risk of skeletal muscle mass loss in patients.