非霍奇金淋巴瘤患儿诱导化疗期间的营养评估

Nutritional assessment of children with non-Hodgkinundefineds lymphoma during induced chemotherapy

目的评估初诊非霍奇金淋巴瘤(non-hodgkinlymphoma,NHL)患儿诱导化疗期间的营养状况,了解其营养不良发生率,以便及时予以营养干预。方法选取2017年1月至2018年12月首都医科大学附属北京儿童医院血液肿瘤中心的257例初治NHL患儿为研究对象,采用营养状况和生长风险筛查工具对患儿的营养风险进行评估,根据身高比体质量进行营养不良情况的分级;测量患儿初诊和诱导化疗结束时的体质量、身高等人体学指标及血红蛋白、前白蛋白、白蛋白等实验室指标。结果中度营养风险223例(86.8%),高度营养风险34例(13.2%)。患儿初治后较治疗前营养状况下降:治疗前轻度营养不良13例、中度1例,超重4例、肥胖3例;治疗后轻度营养不良32例、中度9例、重度5例,超重3例、肥胖2例。96例行营养支持(37.4%),其中肠外营养15例、肠内营养81例。体质量[化疗前(29.50±15.13)kg与化疗后(27.60±14.30)kg]和体质量指数[化疗前(17.20±3.28)kg/m^2与化疗后(16.10±3.13)kg/m^2]明显下降,差异有统计学意义(t=12.404、13.949,P均<0.01)。实验室指标除前白蛋白外,血红蛋白[(109.00±15.78)g/L]、白蛋白[(37.40±4.38)g/L]、淋巴细胞总数[(1.58±1.26)×10^9/L]均低于化疗前血红蛋白[(117.90±21.06)g/L]、白蛋白[(39.60±6.70)g/L]、淋巴细胞总数[(2.98±2.87)×10^9/L](t值分别为6.514、4.834、7.420,P均<0.01)。结论NHL患儿初治后存在较高的营养不良发生率,对患儿及早进行营养风险筛查及优化营养治疗,是改善患儿临床疗效的途径之一。

Objective To evaluate the nutritional status of children with non-Hodgkin lymphoma(NHL)during induction chemotherapy,and to understand the incidence of malnutrition,so as to give nutrition intervention in time.Methods From January 2017 to December 2018,257 children with NHL were selected from the Center for Hematological Oncology,Peking Children′s Hospital Affiliated to Capital Medical University.Nutritional status and growth risk screening tools were used to assess the nutritional risk of the children,and the malnutrition was classified according to the height and body weight.The body mass,height and other anthropometric indexes,hemoglobin,prealbumin,albumin and other laboratory indexes were measured at the end of initial diagnosis and induction chemotherapy.Results There were 223 cases of moderate nutritional risk(86.8%)and 34 cases of high nutritional risk(13.2%).After treatment,the nutritional status of the children decreased:13 cases of mild malnutrition,1 case of moderate malnutrition,4 cases of overweight and 3 cases of obesity before treatment;32 cases of mild malnutrition,9 cases of moderate malnutrition,5 cases of severe malnutrition,3 cases of overweight and 2 cases of obesity after treatment.Ninety-six patients received nutritional support(37.4%),including 15 cases of parenteral nutrition and 81 cases of enteral nutrition.The body weight((29.50±15.13)kg before and after chemotherapy(27.60±14.30)kg)and body mass index((17.2±3.28)kg/m^2 before and(16.1±3.13)kg/m^2 after chemotherapy)decreased significantly(t=12.404,13.949,all P<0.01).Laboratory indicators except prealbumin were lower in hemoglobin((109.00±15.78)g/L),albumin((37.40±4.38)g/L),total lymphocyte((1.58±1.26)×10^9/L)than before treatment(hemoglobin(117.90±21.06)g/L),(albumin(39.60±6.70)g/L),(total lymphocyte(2.98±2.87)×10^9/L))(t=6.514,4.834,7.420,all P<0.01).Conclusion There is a high incidence of malnutrition in NHL children after initial treatment.Early screening of nutritional risk and optimizing nutritional treatment are one of the ways to improve the clinical efficacy of NHL children.