添加谷氨酰胺的肠外营养对儿童造血干细胞移植术后营养支持效果的评价

Nutritional efficacy of glutamine-supplemented parenteral nutrition in children undergoing hematopoietic stem cell transplantation

目的评估添加谷氨酰胺的肠外营养对儿童造血干细胞移植术后营养支持的效果。方法回顾性收集2005年1月至2009年1月在上海儿童医学中心进行造血干细胞移植并予以7d以上肠外营养支持的患儿共48例,其中28例患儿的肠外营养中添加了400mg/(kg·d)谷氨酰胺(谷氨酰胺组),另20例未添加谷氨酰胺(对照组)。移植后24h开始给予肠外营养。移植当天,第7、14和21天测定肝肾功能,记录每天体质量变化、有无口腔溃疡和腹泻发生以及患儿在无菌室治疗天数。结果谷氨酰胺组体重下降较对照组明显;在无菌室滞留时间、口腔溃疡和腹泻发生率好于对照组,但两者之间差异无统计学意义。两组在移植当天至移植后21d期间,谷氨酰胺组肝肾功能变化不大,而对照组第14天ALT(P=0.043)和AST升高;第21天BUN(P=0.021)和Cr升高;两组白蛋白和前白蛋白之间差异无统计学意义。结论添加谷氨酰胺的肠外营养对造血干细胞移植后患儿的肝肾功能影响较小,对减少口腔溃疡和腹泻的发生、缩短无菌室滞留时间,以及改善其营养状况无明显作用。

Objective To assess the nutritional efficacy of glutamine-supplemented parenteral nutrition in children undergoing hematopoietic stem cell transplantation. Methods Forty-eight patients who underwent hematopoietic stem cell transplantation and received parenteral nutrition over 7 days in Shanghai Children＇s Medical Center between January 2005 and January 2009 were enrolled in the study. They were divided into two groups：the group of parenteral nutrition with glutamine 400 mg /（kg·d）（Gln group,n = 28） and the group of parenteral nutrition（control group,n = 20） . Parenteral nutrition was initiated at 24 hours after stem cell transplantation. The results of liver and kidney function examinations were recorded at the day of transplantation,the 7th,14th and 21st day after transplantation. Daily weight change,oral mucositis,diarrhea and time of leaving laminar flow ward were recorded. Results Weight decrease was more obvious in the Gln group than the patients in the control group. Although the gln group had shorter laminar flow ward stay,lower incidences of mucositis and diarrhea,the differences were not significant. ALT（P = 0.043） and AST were increased in the control at the 14th day of transplantation,and the same changes in blood urea nitrogen（P = 0.021） and creatinine were found at the 21st day of transplantation. There were no differences between the two groups in albumin and pre-albumin at the day of transplantation,the 7th,14th and 21st day after transplantation. Conclusions Changes in the liver and kidney functions were less in glutamine-supplemented parenteral nutrition. The effects in decreasing the incidences of mucositis and diarrhea,shortening the laminar flow ward stay,and improving the nutritional status were not significant in glutamine-supplemented parenteral nutrition.