造血干细胞移植患者营养指标与移植早期临床结局的关系

Relationship between nutritional index and early clinical outcome of hematopoietic stem cell transplantation patients

目的探讨造血干细胞移植患者营养指标与移植早期临床结局的关系,为患者实施营养支持及改善预后提供依据。方法选择183例进行异基因造血干细胞移植的血液病患者,在预处理前、移植前、移植后14天、移植后28天,从膳食调查、血液生化指标、人体成分分析3个方面,采用营养风险筛查2002(NRS2002)量表及患者主观整体营养状况评估量表(PG-SGA)进行综合营养评估,并分析移植后28天时异常体成分与移植早期临床结局的关系。结果造血干细胞移植患者均存在营养风险。移植后28天,患者的膳食评分高于移植前1天,患者味觉异常、口腔疼痛/口干、恶心呕吐、腹泻的发生率均低于移植前1天,差异均有统计学意义(P﹤0.05)。预处理前至移植后28天,患者的体重、去脂肪质量(FFM)、骨骼肌质量(SMM)、体细胞质量(BCM)、体重指数(BMI)、去脂体重指数(FFMI)及骨骼肌质量指数(SMI)均呈逐渐下降趋势。移植前及移植后14天,患者的体脂(BF)和体脂指数(FMI)均低于预处理前,但在移植后28天,两者均高于预处理前、移植前及移植后14天,差异均有统计学意义(P﹤0.05)。移植后28天,患者的体脂百分比(PBF)、内脏脂肪面积(VFA)均高于预处理前、移植前及移植后14天,差异均有统计学意义(P﹤0.05)。移植后28天,患者肌少性肥胖发生率高于预处理前、移植前及移植后14天,差异均有统计学意义(P﹤0.05)。移植后28天,患者的葡萄糖、前白蛋白水平均低于移植前,甘油三酯水平高于移植前,差异均有统计学意义(P﹤0.05)。低SMI、肌少性肥胖均与消化道黏膜炎、急性移植物抗宿主病(aGVHD)、非复发死亡的发生有关,高VFA与aGVHD的发生有关。结论造血干细胞移植患者体成分变化的特点为肌肉组织持续下降和脂肪组织先减后增,肌少症和肌少性肥胖与造血干细胞移植早期的不良临床结局有关。

Objective To explore the relationship between nutritional index and early clinical outcome of hematopoietic stem cell transplantation patients,so as to provide a basis for providing nutritional support to patients and to improve their prognosis.Method 183 patients who underwent allogeneic hematopoietic stem cell transplantation were selected.Nutrition assessment were done at 4 time points(before pretreatment,before transplantation,14 days after transplantation and 28 days after transplantation).Dietary survey,blood biochemical indexes,body component were analyzed,nutritional risk screening 2002(NRS2002)and patient-generated subjective global assessment(PG-SGA)were used for comprehensive nutritional assessment.The relationship between abnormal body composition and early clinical outcome was analyzed 28 days after transplantation.Result All patients with hematopoietic stem cell transplantation had nutritional risk.At 28 days after transplantation,the patients’dietary score was higher than that on the 1 st day before transplantation,and the incidence of abnormal taste,oral pain/dry mouth,nausea and vomiting and diarrhea were lower than that on the 1 st day before transplantation(P<0.05).From pretreatment to 28 days after transplantation,the patients’body weight,fatfree mass(FFM),skeletal muscle mass(SMM),body cell mass(BCM),body mass index(BMI),fat-free mass index(FFMI)and skeletal muscle index(SMI)showed a downward trend.Before transplantation and 14 days after transplantation,the body fat(BF)and fat mass index(FMI)of patients were lower than those before pretreatment,but at 28 days after transplantation,they were higher than those before pretreatment,before transplantation and 14 days after transplantation(P<0.05).At 28 days after transplantation,the percentage of body fat(PBF)and visceral fat area(VFA)were significantly higher than those before pretreatment,before transplantation and 14 days after transplantation(P<0.05).28 days after transplantation,the incidence of sarcopenic obesity was higher than that before pretreatment,before transplantation and14 days after transplantation(P<0.05).28 days after transplantation,the levels of glucose and prealbumin were lower than those before transplantation,and the level of triglyceride was higher than that before transplantation(P<0.05).Low SMI and sarcopenic obesity were related to gastrointestinal mucositis,acute graft versus host disease(aGVHD)and non-recurrent death,while high VFA was related to aGVHD.Conclusion The changes in the composition of hematopoietic stem cell transplantation patients were characterized by continuous decrease in muscle tissue and decrease first and then increase in adipose tissue.Sarcopenia and sarcopenic obesity are associated with early adverse clinical outcomes of hematopoietic stem cell transplantation.