骨髓移植患者营养治疗专家共识

Expert consensus on nutritional therapy for patients with bone marrow transplant

骨髓移植前,清髓药物的不良反应会使患者的食欲、味觉、唾液腺功能、胃排空和肠道功能减退,并可引起严重的黏膜炎及移植物抗宿主病(GVHD),进而继发营养不良。GVHD可直接损伤皮肤、肝脏、黏膜、肺部、食管及肌肉骨骼等器官和组织,且长期应用免疫抑制剂防治GVHD,可导致内分泌和代谢系统疾病,包括胰岛素抵抗、脂质代谢异常、甲状腺功能减退或性腺功能减退等,从而导致营养不良。移植前已存在营养不良的患者接受异基因骨髓移植后营养不良可持续长达数年。通过营养治疗改善患者的营养状态,不仅可以减少移植患者急性GVHD的发生率,缩短植入时间,还可降低感染相关死亡率,延长生存期。

Prior to bone marrow transplantation,adverse reactions to myeloablative drugs can lead to decreased appetite,taste,salivary gland function,gastric enptying,and intestinal function in patients,as well 88 severe mucosal inflammation and graft versus host disease(GVHD),leading to scondary malnutrition.GVHD can directly damage organs and tssues such as the skin,liver,mucosa,lunge,esophagus,and musculoskeletal system.Long term use of immwnosuppressants to prevent and treat GVHD can lead to endocrine and metabolic system diseases,including insulin resitance,abnomal lipid metabolism,bypothyroidism or hypogonadism,resuling in malnutrition.Patients with pre-existing malnutrition before transplantation can sustain malnutition for several years after receiving allogeneic bone marrow transplantation.Improving the nutritional status of patients through nutritional therapy can not only reduce the incidence of acute GVHD in transplant patients,shorten implantation time,but also reduce infetion related mortality and prolong survival.