CAJ | 학술논문

目的探讨肠外营养(PN)支持对造血干细胞移植患者的重要性及各种营养素的作用.方法回顾性分析2008年1月至2009年9月106例接受造血干细胞移植患者的临床资料,根据营养支持方式不同分为PN组(n=42)和非PN组(n=64),比较两组患者在造血重建时间、口腔黏膜炎、肝功能异常、感染及移植物抗宿主病(GVHD)发生率等方面的差异;进一步分析核黄素、谷氨酰胺、结构脂肪乳等营养素的作用.结果接受PN支持的42例患者中,包含接受核黄素的患者33例,谷氨酰胺24例,结构脂肪乳26例.PN组患者的口腔黏膜炎发生率显著低于非PN组(31.0％比51.6％,P=0.036),而两组的感染率(42.9％比46.9％,P=0.898)、GVHD发生率(21.4％比31.3％,P=0.267)、丙氨酸氨基转移酶(ALT)水平[(49.5±9.8) U/L比(69.9±10.9) U/L,P =0.196]、粒系重建时间[(11.6±0.3)d比(12.3±0.3)d,P=0.187]及血小板重建时间[(14.1±0.9)d比(13.3±0.4)d,P=0.386]差异均无统计学意义.核黄素组的口腔黏膜炎发生率为27.3％,有低于无核黄素组(44.4％)和非PN组(51.6％)的趋势,但差异无统计学意义(P =0.073).谷氨酰胺组、无谷氨酰胺组和非PN组在口腔黏膜炎发生率、感染率、GVHD发生率、ALT水平及造血重建时间方面的差异均无统计学意义(P均＞0.05).结构脂肪乳组的ALT平均值为(38.7±4.9) U/L,有低于物理混合的中长链脂肪乳组[(68.5±23.0) U/L]和非PN组[(69.9±10.9) U/L]的趋势,但差异无统计学意义(P =0.243).结论造血干细胞移植患者可从合理的PN中获益.核黄素对口腔黏膜炎的预防可能有益.结构脂肪乳与中长链脂肪乳对于肝脏功能具有同样的安全性.谷氨酰胺的作用有待进一步研究.
목적 탐토장외영양(PN)지지대조혈간세포이식환자적중요성급각충영양소적작용.방법 회고성분석2008년1월지2009년9월106례접수조혈간세포이식환자적림상자료,근거영양지지방식불동분위PN조(n=42)화비PN조(n=64),비교량조환자재조혈중건시간、구강점막염、간공능이상、감염급이식물항숙주병(GVHD)발생솔등방면적차이;진일보분석핵황소、곡안선알、결구지방유등영양소적작용.결과 접수PN지지적42례환자중,포함접수핵황소적환자33례,곡안선알24례,결구지방유26례.PN조환자적구강점막염발생솔현저저우비PN조(31.0％비51.6％,P=0.036),이량조적감염솔(42.9％비46.9％,P=0.898)、GVHD발생솔(21.4％비31.3％,P=0.267)、병안산안기전이매(ALT)수평[(49.5±9.8) U/L비(69.9±10.9) U/L,P =0.196]、립계중건시간[(11.6±0.3)d비(12.3±0.3)d,P=0.187]급혈소판중건시간[(14.1±0.9)d비(13.3±0.4)d,P=0.386]차이균무통계학의의.핵황소조적구강점막염발생솔위27.3％,유저우무핵황소조(44.4％)화비PN조(51.6％)적추세,단차이무통계학의의(P =0.073).곡안선알조、무곡안선알조화비PN조재구강점막염발생솔、감염솔、GVHD발생솔、ALT수평급조혈중건시간방면적차이균무통계학의의(P균＞0.05).결구지방유조적ALT평균치위(38.7±4.9) U/L,유저우물리혼합적중장련지방유조[(68.5±23.0) U/L]화비PN조[(69.9±10.9) U/L]적추세,단차이무통계학의의(P =0.243).결론 조혈간세포이식환자가종합리적PN중획익.핵황소대구강점막염적예방가능유익.결구지방유여중장련지방유대우간장공능구유동양적안전성.곡안선알적작용유대진일보연구.
Objective To investigate the role of parenteral nutrition (PN) in patients undergoing hematopoietic stem cell transplantation (HSCT).Methods The clinical data of 106 patients who had undergone HSCT from January 2008 to September 2009 were retrospectively analyzed.These patients were divided into PN group (n =42) and non-PN group (n =64) based on their nutrition support modes and then compared in terms of time of hematopoietic reconstruction,oral mucositis,liver function,infections,and graft-versus-host disease (GVHD).The PN group was further divided into riboflavin group,glutamine group and structolipid group to explore the roles of different nutrients.Results In the 42 patients receiving PN support,33 patients were treated with riboflavin,24 with glutamine,and 26 with structolipid.In the PN group and non-PN group,the incidence of oral mucositis was 31.0％ and 51.6％ (P =0.036),the incidence of infections was 42.9％ and 46.9％ (P =0.898),the incidence of GVHD was 21.4％ and 31.3％ (P =0.267),the ALT level was (49.5 ±9.8) U/L and (69.9 ± 10.9) U/L (P =0.196),the average time of granulocyte reconstruction was (11.6 ± 0.3) days and (12.3 ± 0.3) days (P =0.187),and the average time of platelet reconstruction was (14.1 ±0.9) days and (13.3 ±0.4) days (P =0.386),respectively.The incidence of oral mucositis in the riboflavin group (27.3％) was lower than those in the non-riboflavin group (44.4％) and non-PN group (51.6％) (P =0.073).Among glutamine group,non-glutamine group,and non-PN group,no statistically significant differences were found in the incidence of oral mucositis,infection,GVHD,ALT level and hematopoietic reconstruction time (all P ＞ 0.05).The ALT level in the structolipid group [(38.7 ± 4.9) U/L] was lower than those in medium-and long-chain fat emulsion group [(68.5 ± 23.0) U/L] and non-PN group [(69.9 ± 10.9) U/L] (P =0.243),but the differences were not statistically significant.Conclusions Patients who have undergone HSCT can benefit from proper PN.Riboflavin may prevent oral mucositis and structolipid may be equally safe for liver as medium-and long-chain fat emulsion.The role of glutamine in this condition needs further research.