中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2014年
2期
67-73
,共7页
费俊%潘莉雅%朱晨临%冯一%赵卓琦%洪莉
費俊%潘莉雅%硃晨臨%馮一%趙卓琦%洪莉
비준%반리아%주신림%풍일%조탁기%홍리
造血干细胞移植%口服营养素%营养指导%高蛋白营养
造血榦細胞移植%口服營養素%營養指導%高蛋白營養
조혈간세포이식%구복영양소%영양지도%고단백영양
Hematopoietic stem cell transplantation%Oral nutrient intake%Nutrition guidance%High protein diet
目的 分析骨髓移植患儿移植期间营养摄入及营养状况的改变,评估营养干预的重要性.方法 以2012年1月至2012年11月在上海交通大学医学院附属上海儿童医学中心血液肿瘤科行骨髓移植的共计65名患儿为研究对象.以预处理前收集的患儿资料为基线值.预处理开始后至移植后30 d每周2次、移植后30～100 d每周1次收集患儿营养相关资料,并对患儿日常营养摄入进行膳食分析.在相应时间点收集患儿24h小便行定氮分析.结果 患儿总能量和各项宏量营养素口服摄入基线值分别为:总能量(5 844.9±2 490.4) kJ/d,蛋白质(56.4±28.6) g/d,脂肪(49.7±38.9) g/d,碳水化合物(190.9±91.1) g/d.随着移植预处理开始,各项摄入均明显减少(P均=0.000).移植后恢复期,患儿能量摄入自第6周开始与基线值差异无统计学意义,蛋白质自第13周开始与基线水平差异无统计学意义,碳水化合物和脂肪摄入分别自第4周和第6周起与基线水平差异无统计学意义.移植前患儿尿氮排出量为(3.9±2.4) g/d,进行预处理后尿氮量达到(16.7±11.0) g/d,显著高于基线尿氮量(P =0.000).患儿移植后第1周的体重(P=0.000)、三头肌皮褶厚度(P=0.003)、中上臂围(P =0.000)、血清白蛋白(P =0.000)、前白蛋白(P =0.000)均显著低于基线值;移植后第9周的去脂百分比(P =0.010)、肌肉百分比(P =0.001)和蛋白质百分比(P =0.000)显著低于基线值,体脂百分比显著高于基线值(P =0.000).结论 骨髓移植患儿早期即有营养摄入量的改变,在移植恢复期逐渐恢复,其中蛋白质摄入恢复最慢,可能是影响患儿血清蛋白水平的重要因素.因此,骨髓移植患儿需要更为详细的营养指导,尽量以口服摄入满足营养需求,必要时可提供高蛋白营养配方.
目的 分析骨髓移植患兒移植期間營養攝入及營養狀況的改變,評估營養榦預的重要性.方法 以2012年1月至2012年11月在上海交通大學醫學院附屬上海兒童醫學中心血液腫瘤科行骨髓移植的共計65名患兒為研究對象.以預處理前收集的患兒資料為基線值.預處理開始後至移植後30 d每週2次、移植後30～100 d每週1次收集患兒營養相關資料,併對患兒日常營養攝入進行膳食分析.在相應時間點收集患兒24h小便行定氮分析.結果 患兒總能量和各項宏量營養素口服攝入基線值分彆為:總能量(5 844.9±2 490.4) kJ/d,蛋白質(56.4±28.6) g/d,脂肪(49.7±38.9) g/d,碳水化閤物(190.9±91.1) g/d.隨著移植預處理開始,各項攝入均明顯減少(P均=0.000).移植後恢複期,患兒能量攝入自第6週開始與基線值差異無統計學意義,蛋白質自第13週開始與基線水平差異無統計學意義,碳水化閤物和脂肪攝入分彆自第4週和第6週起與基線水平差異無統計學意義.移植前患兒尿氮排齣量為(3.9±2.4) g/d,進行預處理後尿氮量達到(16.7±11.0) g/d,顯著高于基線尿氮量(P =0.000).患兒移植後第1週的體重(P=0.000)、三頭肌皮褶厚度(P=0.003)、中上臂圍(P =0.000)、血清白蛋白(P =0.000)、前白蛋白(P =0.000)均顯著低于基線值;移植後第9週的去脂百分比(P =0.010)、肌肉百分比(P =0.001)和蛋白質百分比(P =0.000)顯著低于基線值,體脂百分比顯著高于基線值(P =0.000).結論 骨髓移植患兒早期即有營養攝入量的改變,在移植恢複期逐漸恢複,其中蛋白質攝入恢複最慢,可能是影響患兒血清蛋白水平的重要因素.因此,骨髓移植患兒需要更為詳細的營養指導,儘量以口服攝入滿足營養需求,必要時可提供高蛋白營養配方.
목적 분석골수이식환인이식기간영양섭입급영양상황적개변,평고영양간예적중요성.방법 이2012년1월지2012년11월재상해교통대학의학원부속상해인동의학중심혈액종류과행골수이식적공계65명환인위연구대상.이예처리전수집적환인자료위기선치.예처리개시후지이식후30 d매주2차、이식후30～100 d매주1차수집환인영양상관자료,병대환인일상영양섭입진행선식분석.재상응시간점수집환인24h소편행정담분석.결과 환인총능량화각항굉량영양소구복섭입기선치분별위:총능량(5 844.9±2 490.4) kJ/d,단백질(56.4±28.6) g/d,지방(49.7±38.9) g/d,탄수화합물(190.9±91.1) g/d.수착이식예처리개시,각항섭입균명현감소(P균=0.000).이식후회복기,환인능량섭입자제6주개시여기선치차이무통계학의의,단백질자제13주개시여기선수평차이무통계학의의,탄수화합물화지방섭입분별자제4주화제6주기여기선수평차이무통계학의의.이식전환인뇨담배출량위(3.9±2.4) g/d,진행예처리후뇨담량체도(16.7±11.0) g/d,현저고우기선뇨담량(P =0.000).환인이식후제1주적체중(P=0.000)、삼두기피습후도(P=0.003)、중상비위(P =0.000)、혈청백단백(P =0.000)、전백단백(P =0.000)균현저저우기선치;이식후제9주적거지백분비(P =0.010)、기육백분비(P =0.001)화단백질백분비(P =0.000)현저저우기선치,체지백분비현저고우기선치(P =0.000).결론 골수이식환인조기즉유영양섭입량적개변,재이식회복기축점회복,기중단백질섭입회복최만,가능시영향환인혈청단백수평적중요인소.인차,골수이식환인수요경위상세적영양지도,진량이구복섭입만족영양수구,필요시가제공고단백영양배방.
Objective To explore the change of dietary intake and nutritional status before and after hematopoietic stem cell transplantation (HSCT) in pediatric patients to assess the importance of nutritional interventions.Methods In this observational cohort study,65 children undergoing HSCT between January 2012 and November 2012 in the Department of Hematology and Oncology,Shanghai Children's Medical Center were enrolled.The data collected before preconditioning were considered as the baseline data.We also collected data twice a week between preconditioning and 30 days after HSCT,and once a week from 30 days to 100 days after HSCT.Dietary analysis and urea nitrogen analysis were conducted in parallel.Results The baseline level of energy intake was (5 844.9 ±2 490.4) kJ/d,protein intake was (56.4 ±28.6) g/d,fat intake was (49.7 ±38.9) g/d,and carbohydrate intake was (190.9 ± 91.1) g/d.With the hematopoietic reconstruction,the oral nutrients intake significantly decreased compared with the baseline levels (all P =0.000).During the recovery period after HSCT,the energy intake showed no significant difference when compared with the baseline level in the 6th postoperative week,protein in the 13th week,carbohydrate in the 4th week,and fat in the 6th week.The urine nitrogen was (3.9 ± 2.4) g/d before HSCT,which increased to (16.7 ± 11.0) g/d after preconditioning (P=0.000).In the 1st postoperative week,the weight (P =0.000),triceps skin fold thickness (P =0.003),mid-upper arm circumference (P =0.000),serum albumin (P =0.000) and prealbumin (P =0.000) of the patients all significantly decreased compared with the baseline levels.In the 9th postoperative week,the fat-free body weight percentage (P =0.010),muscle percentage (P =0.001) and protein percentage (P =0.000) were significantly lower than the baseline levels,while the body fat percentage was higher than the baseline level (P =0.002).Conclusions Children undergoing HSCT exhibit a marked reduction in nutrient intakes at the early stage of HSCT,which may gradually return normal during the recovery period.This process may be slow,especially for the protein,and therefore may affect the serum protein level in these pediatric patients.Thus,more careful nutrition guidance is necessary during HSCT for pediatric patients,emphasizing oral nutrients intakes,and high protein dietary or formula may be helpful.
