口服VitC及VitE对缓解骨髓移植术相关毒性的临床观察

The Impact of Vit C and Vit E on Transplant-related Toxicities in 20 Patients with Bone Marrow Transplantation

目的研究补充抗氧化性维生素对于增强骨髓移植患者血浆总抗氧化力(TAC),降低脂质过氧化(MDA),缓解移植术相关毒性的作用。方法随机、单盲设计,选择20例骨髓移植患者随机分为2组,实验组于预处理前给予VitC(300mg/d)及VitE(600mg/d),对照组不予补充,其余处理两者同。测定移植前后两组患者血浆TAC、MDA以及血胆红素、肌酐、L-乳酸脱氢酶的浓度,观察并记录两组患者口腔溃疡(OM)的发生及其程度。结果(1)移植前后实验组TAC值一直处于正常或高于正常对照值,对照组则低于正常,两者有显著差异;移植后对照组MDA值与实验组有显著差异,实验组移植后很快降至正常,对照组一直处于较高水平。(2)实验组患者在OM的发生及程度上、心肌毒性、肝脏毒性指标上与对照组有差异;在肾脏毒性指标方面两组患者无差异。结论移植前外源性补充抗氧化性维生素可提高骨髓移植患者机体的抗氧化力,减少脂质过氧化物的产生,有效缓解移植术后部分相关毒性。

Objectives To study the efficacy of supplying bone marrow transplantation patients antioxidative vitamins such as Vit C and Vit E as to whether they could develop their plasma antioxidative capacity and reduce lipid peroxid ation status and whether they could reduce transplant -related toxicities.Methods 20bone marrow transplantation (BMT)patients were randomly divided into2groups.The study group patients were given Vit C (300mg /d)and Vit E (600mg /d)for15days before the pretreatment of BMT,the control group patients were given nothing while other interventions were the same.The levels of total antioxidative capacity (TAC)and malondialdehyde(MDA)in plasma,the levels of bilirubin,creatinine and L-LDH in serum before and after BMT were detected,and the incidence and degree of oral mucositis after BMT were observed and recorded.Results(1)The level of the TAC was with in or near the normal range in the study group,but below the normal range in the control group.There were significant differences between the two groups before and after BMT.Significant differences of plasma MDA between the two groups were found after BMT,the MDA of the study group dropped into normal range rapidly,but that of the control group maintained above the normal range during the study.(2)There were significant differences of the incidence and degree of oral mucositis,cardiac toxicity and hepatic toxicity between the two groups.There were no significant differences of nephrotoxicity between the two groups after BMT.Conclusions Supplying the patients with Vit C,Vit E before BMT could help to develop the antioxidative capacity of the BMT patients,and reduce production of the lipid peroxide.The patients transplant -related toxicities associated with high-dose chemotherapy and total body irradiation before BMT was eliminated effectively.