老年非M3型急性髓系白血病化疗前后营养状态评估与营养支持研究  

Evaluation of nutritional status and nutritional support in elderly patients with non-M3 acute myeloid leukemia before and after chemotherapy

作　　者：王薇 何璇 贾蕾 马欢[2] Wang Wei;He Xuan;Jia Lei;Ma Huan(Department of Hematology,West China Hospital,Sichuan University/West China School of Nursing,Sichuan University,Chengdu,Sichuan,610041,P.R.China;Department of Gastroenterology,Central Hospital of Mianyang City,Mianyang,Sichuan,621000,P.R.China)

机构地区：[1]四川大学华西医院血液内科/四川大学华西护理学院,四川成都610041 [2]绵阳市中心医院消化内科,四川绵阳621000

出　　处：《老年医学与保健》2021年第6期1144-1149,共6页Geriatrics & Health Care

基　　金：四川省卫生和计划生育委员会科研课题(18PJ395)。

摘　　要：目的探析老年非M3型急性髓系白血病(AML)患者化疗前后营养状态及营养支持情况。方法选择2019年1月—2020年1月于四川大学华西医院血液内科收治的147例老年非M3型AML化疗患者,采用主观整体评估法(PG-SGA)对其进行营养状况评估,将PG-SGA评分≤3分的患者设为对照组,PG-SGA评分≥4分的患者设为干预组。干预组患者接受对症营养支持。记录2组化疗期间营养摄入情况,测定2组化疗前后营养指标,比较不良反应及疗效。结果化疗前,147例非M3型AML患者中,PG-SGA评分≥4分者78例,占比53.06%;不同年龄患者间PG-SGA评分比较无统计学差异(P>0.05),但年龄≥75岁患者中,PG-SGA评分≥9分占比明显高于<75岁患者(P<0.05);不同BMI患者的PG-SGA评分存在差异,BMI<18.5 kg/m^(2)患者PG-SGA评分0~1分占比低于BMI 18.5~24 kg/m^(2)及BMI>24kg/m2患者,而PG-SGA评分≥9分占比高于BMI 18.5~24 kg/m^(2)及BMI>24 kg/m^(2)患者(P<0.05)。化疗后,各组人体测量学参数(BMI、腰臀比和上臂围)、实验室生化指标[血清总蛋白(TP)、前清蛋白(PA)、清蛋白(ALB)和铁转蛋白(TF)]明显低于同组化疗前,而干预组上述指标值均显著高于对照组(P<0.05)。干预组化疗期间不良反应总发生率显著低于对照组(25.64%vs 55.07%,P<0.05)。化疗3个周期后,干预组完全缓解(CR)率和总体缓解(OR)率均明显高于对照组(56.41%vs 39.13%、80.77%vs 60.87%,P<0.05)。结论老年非M3型AML患者营养不良发生率较高,化疗期间给予对症营养支持能有效改善其营养状态,提高化疗效果,同时减少化疗相关不良反应。Objective To explore the nutritional status and nutritional support of elderly patients with non-M3 acute myeloid leukemia(AML)before and after chemotherapy.Methods 147 elderly patients with non-M3 AML treated in the Department of Hematology,West China Hospital of Sichuan University from January 2019 to January 2020 were selected.Their nutritional status was evaluated with Patient-Generated Subjective Global Assessment(PG-SGA).According to the evaluation results,they were divided into the control group(PG-SGA score≤3)and intervention group(PG-SGA score≥4).The patients in the intervention group were given symptomatic nutritional support.The nutritional intake of the two groups during chemotherapy was recorded and the nutritional indexes of the two groups before and after chemotherapy were measured.The adverse reactions and curative effects were compared between the two groups.Results Before chemotherapy,78 of the 147 non-M3 AML patients had a PG-SGA score≥4,accounting for 53.06%.There was no significant difference in PG-SGA scores among patients with different ages(P>0.05),but the proportion of PG-SGA score≥9 in patients aged≥75 years was significantly higher than that in patients aged<75 years(P<0.05).There were differences in the PG-SGA scores among patients with different BMI.The proportion of PG-SGA scores of 0-1 in patients with BMI<18.5 kg/m^(2) was lower than that of patients with BMI 18.5-24 kg/m^(2) and BMI>24 kg/m^(2),while the proportion of PG-SGA score≥9 was higher than that of patients with BMI 18.5-24 kg/m^(2) and BMI>24 kg/m^(2)(P<0.05).After chemotherapy,anthropometric parameters(BMI,waist hip ratio and upper arm circumference)and laboratory biochemical indexes[serum total protein(TP),prealbumin(PA),albumin(ALB)and transferrin(TF)]of the two groups were significantly lower than those of the same group before chemotherapy,while the above indexes of the intervention group were significantly higher than those of the control group(P<0.05).During chemotherapy,the total incidence of adverse r

关 键 词：老年 急性髓系白血病 化疗 营养支持 营养状态 

分 类 号：R733.71[医药卫生—肿瘤]