評估肝癌病人的營養風險及生活品質

Evaluation of nutrition risk and quality of life of patients with hepatocellular carcinoma

詹淑卿(Shu-Ching Chan)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所/碩士(2008年)

摘要

研究動機：肝癌好發於亞洲地區之華人，過去由於預後不好，因此營養狀況與生活品質的相關研究相當有限。由於醫療的進步，雖然存活率已明顯提高，但對肝癌病患的營養問題仍待加以探討。
研究目的：本研究旨在評估肝癌病患的營養狀況及生活品質，並分析營養狀況之預測因子。
研究方法：以中部某區域醫院放射腫瘤科門診肝癌病患171人為研究對象，進行問卷訪談與體位及血液生化檢測。問卷包括台灣修訂版簡易營養評估 (Mini Nutritional Assessment, MNA)、食慾自評量表 (Council on Nutrition appetite questionnaire, CNAQ) 以及歐洲癌症治療與研究組織生活品質量表 (European Organization for Research and Treatment of Cancer Quality of Life Core-30, EORTC QLQ-C30) 等；體位測量包括身高、體重、身體質量指數 (body mass index, BMI)、臂中圍及小腿圍。MNA台灣修訂版修訂一以台灣族群代表性體位指標取代原量表之分切點，而修訂二則省略BMI題並調整配分。資料經整理及電腦鍵入之後，以描述性統計、皮爾森相關分析 (Pearson correlation)、魏可遜配對組符號等級考驗 (Wilcoxon Matched-Pairs Signed-Rank Test) 及多元廻歸分析進行分析。
研究結果：兩修訂版分別評定2.3%及1.8%病患為營養不良，50.3%及48.0%具風險，47.4%及50.3%營養良好。兩版本之總分均與主要營養或病情指標血紅素、血清白蛋白、C-反應蛋白 (C-reactive protein, CRP)、食慾、%體重改變及肝硬化級別呈近似程度高度相關 (以上皆P<0.001)；r-GT、BUN、肌氨酸酐、腫瘤分期及處方藥數亦呈顯著相關。以逐步迴歸分析顯示血清白蛋白、r-GT、CRP、食慾、%體重改變、處方藥數、BMI、臂中圍、小腿圍為營養狀況之顯著預測因子。肝癌病患的「整體生活品質及健康狀況」平均是53.6 ± 22.4；五種功能性尺度以「角色功能」較佳 (80.1 ± 28.6)，而「認知功能」 (72.4± 20.3) 和「社會功能」 (72.2± 25.1) 相對較差。
結論：本研究顯示MNA台灣修訂版可以有效檢測肝癌病患的營養風險，近半數之病患具營養風險且其整體生活品質與健康不夠理想。肝癌病患的%體重減輕和處方藥數愈多、食慾狀態愈差、血清白蛋白愈低、r-GT和CRP愈高和體位測量因素 (小腿圍、臂中圍、BMI) 數值愈小者，營養不良的狀況愈嚴重。此外，除了加強醫藥治療，積極的心理諮商對病患之營養狀況亦有所改善。

關鍵字

肝癌 ； 營養評估 ； 營養不良 ； 生活品質

並列摘要

Background: The prevalence of hepatocellular carcinoma is high among Chinese populations. Hepatocellular carcinoma often affects one's nutritional status and quality of life. Monitoring the nutritional status is important in liver cancer patients.
Objective: The objective of this study was to assess the nutritional status and quality of life of patients with hepatocellular carcinoma and to analyze the factors that can impact the nutritional status.
Methods: Using patients at the department of radiation oncology of a teaching hospital in Central Taiwan as a convenient sample, 171 patients with hepatocellular carcinoma agreed to participate in the study. Each subject was interviewed for eliciting personal data, health/disease conditions and answers to questions in MNA (Mini-Nutritional Assessment), CNAQ (Council on Nutrition Appetite Questionnaire), and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Core-30). Anthropometric measurements were also carried out. Biochemical data were obtained from their routine measurements conducted at the hospital. Each patient's nutritional status was evaluated with two modified versions of the MNA. Version I adopted population-specific anthropometric cut-points and Version II further had the BMI question deleted from the scale and adjusted the scoring. The study protocol was approved by the institutional review boards of Asia University.
Results: MNA-TI and MNA-TII graded 2.3 and 1.8% patients malnourished, 50.3 and 48.0% at risk of malnutrition, and 47.4 and 50.3% normal, respectively. The total scores of the two versions correlated with hemoglobin, serum albumin, C-reactive protein, appetite status, % weight change, liver cirrhosis status (all above, P<0.001); r-GT, blood urea nitrogen, serum creatinine, tumor stages and number of prescribed drugs (all P<0.05). Regression analysis suggested that % body weight change, number of prescribed drugs, calf circumference and mid-arm circumference were the major predictors of nutritional status.
Discussion: Results of the present study show that the MNA is an effective tool in grading the nutritional status of liver cancer patients. Nearly 50% of patients with hepatocellular carcinoma in Taiwan are malnourished or at risk of nutritional deficiency. Routine use of MNA will enable timely detection of emerging nutritional problems and avoid nutritional deficiencies.

並列關鍵字

hepatocellular carcinoma ； nutritional status ； nutritional assessment ； quality of life

參考文獻

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