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1、,肿瘤患者临床营养问题与评估,张 宇,目录, ,肿瘤患者营养不良现状 营养不良对肿瘤预后的影响 营养不良的肿瘤患者治疗现状 肿瘤患者营养治疗方法选择,目录, ,肿瘤患者营养不良现状 营养不良对肿瘤预后的影响 营养不良的肿瘤患者治疗现状 肿瘤患者营养评估,肿瘤患者营养代谢发生改变,Marn Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007 Jun;26(3):289-301.,肿瘤患者随分期升高，营养摄入量,
2、明显下降，导致体重丢失,Ravasco P, Monteiro-Grillo I, Vidal PM, et al. Cancer: disease and nutrition are key determinants of patients quality of life. Support Care Cancer. 2004 Apr;12(4):246-52.,众多内科疾病中，肿瘤是营养不良,发生率最高的,Meijers JM, Schols JM, van Bokhorst-de van der Schueren MA, et al. Malnutrition prevalence in
3、The Netherlands: results of the annual dutch national prevalence measurement of care problems. Br J Nutr. 2009 Feb;101(3):417-23.,近年来多个研究中的肿瘤营养风险,发生率,Yu K, Zhou XR, He SL. A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in patients with c
4、ancer. Eur J Clin Nutr. 2013 Jul;67(7):732-7.,不同部位肿瘤的营养风险发生率比较, ,Figure 1. The prevalence of nutritional risk at admission and at 2 weeks after admission or discharge according to the different sites of primary tumors. A at admission, B 2 weeks after admission or discharge. PAN pancreas, CAR cardiac
5、, STO stomach, ESO esophagus, COL colon, LIV liver, REC rectus, UN lung, BRE breast.,Yu K, Zhou XR, He SL. A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in patients with cancer. Eur J Clin Nutr. 2013 Jul;67(7):732-7.,肿瘤患者发生营养不良,的危险因素,Pr
6、essoir M, Desn S, Berchery D, et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer. 2010 Mar 16;102(6):966-71.,化疗本身会加重患者的营养不良,Malihi Z, Kandiah M, Chan YM, et al. Nutritional status and quality of life in patients with acute le
7、ukaemia prior to and after induction chemotherapy in three hospitals in Tehran, Iran: a prospective study. J Hum Nutr Diet. 2013 Jul;26 Suppl 1:123-31.,目录, ,肿瘤患者营养不良现状 营养不良对肿瘤预后的影响 营养不良的肿瘤患者治疗现状 肿瘤患者营养评估,肿瘤患者营养状态与全身炎症水平,密切相关,Gomes de Lima KV, Maio R. Nutritional status, systemic inflammation and pro
8、gnosis of patients with gastrointestinal cancer. Nutr Hosp. 2012 May-Jun;27(3):707-14.,营养不良的肿瘤患者，化疗相关毒,副作用发生率显著升高,Barret M, Malka D, Aparicio T, et al. Nutritional status affects treatment tolerability and survival in metastatic colorectal cancer patients: results of an AGEO prospective multicenter
9、study. Oncology. 2011;81(5-6):395-402.,住院期间各种并发症发生率的比较,（有营养风险 vs 无营养风险）,Yu K, Zhou XR, He SL. A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in patients with cancer. Eur J Clin Nutr. 2013 Jul;67(7):732-7.,肿瘤相关营养不良降低肿瘤患者生,活质量,Marn Caro MM
10、, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007 Jun;26(3):289-301.,体重丢失10%者，生活质量显著下,降,Nourissat A, Vasson MP, Merrouche Y, et al. Relationship between nutritional status and quality of life in patients with cancer. Eur J Cancer. 2008 J
11、un;44(9):1238-42.,严重营养不良患者生存率显著低于 无营养不良或轻度营养不良的患者,Barret M, Malka D, Aparicio T, et al. Nutritional status affects treatment tolerability and survival in metastatic colorectal cancer patients: results of an AGEO prospective multicenter study. Oncology. 2011;81(5-6):395-402.,营养支持治疗对体重下降/不良反应发生率的影响,RR
12、=相对危险度；95% CI=95%可信限,a 以年龄、性别、分期、手术和放化疗进行校正 b以年龄、性别、分期和放化疗进行校正,Pan H, Cai S, Ji J, et al. The impact of nutritional status, nutritional risk, and nutritional treatment on clinical outcome of 2248 hospitalized cancer patients: a multi-center, prospective cohort study in Chinese teaching hospitals. Nu
13、tr Cancer. 2013;65(1):62-70.,营养支持显著减少化疗相关毒副反,应的发生,Hasenberg T, Essenbreis M, Herold A, et al. Early supplementation of parenteral nutrition is capable of improving quality of life, chemotherapy-related toxicity and body composition in patients with advanced colorectal carcinoma undergoing palliative
14、 treatment: results from a prospective, randomized clinical trial. Colorectal Dis. 2010 Oct;12(10 Online):e190-9.,肿瘤患者营养治疗能改善生活质量,Marn Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007 Jun;26(3):289-301.,接受积极营养治疗的肿瘤患者，生,存率得到改善, Th
15、e KaplanMeier survival plot of,patients who did (n= 23) and did not(n= 30) receive invasive,nutritional support before self- expanding metal stent insertion (83.9 vs. 151.3 days,P= 0.053),Gray RT, Odonnell ME, Scott RD, et al. Impact of nutritional factors on survival in patients with inoperable oes
16、ophageal cancer undergoing self-expanding metal stent insertion. Eur J Gastroenterol Hepatol. 2011 Jun;23(6):455-60.,目录, ,肿瘤患者营养不良现状 营养不良对肿瘤预后的影响 营养不良的肿瘤患者治疗现状 肿瘤患者营养评估,我国肿瘤患者营养治疗现状, 营养治疗的患者比例, 所有住院肿瘤患者中，有34.9%接受营养治疗 有营养风险的患者，仅46.7%得到营养治疗 无营养风险的患者，17.1%实施了营养治疗, 肠外营养（PN） vs 肠内营养（EN）, 30.6%的住院肿瘤患者接受PN 4.4%的住院肿瘤患者接受EN PN：EN = 7：1,Yu K, Zhou XR, He SL. A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in pati
