不同营养评价指标在急性淋巴细胞白血病患儿诱导缓解期的临床应用价值  

Clinical value of different nutritional evaluation indexes in acute lymphoblastic leukemia pediatric patients during the stage of remission induction

作　　者：张晓艳 何梦雪 张冰花[1] Zhang Xiaoyan;He Mengxue;Zhang Binghua(Department of Hematology and Oncology,Shanghai Children′s Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心血液肿瘤科,上海200127

出　　处：《中国实用护理杂志》2022年第25期1933-1938,共6页Chinese Journal of Practical Nursing

基　　金：上海交通大学护理学院护理高原学科建设项目(Hlgy1918kygg)。

摘　　要：目的比较不同营养评价指标在评估急性淋巴细胞白血病(ALL)诱导缓解期患儿营养状况的评价效果,分析不同指标在ALL患儿诱导缓解期间的临床应用价值。方法便利选取2018年1月至2020年12月在上海交通大学医学院附属上海儿童医学中心确诊为ALL并进行诱导缓解化疗的132例患儿的临床资料,以直接节段多频生物电阻抗(DSM-BIA)法测定患儿的肌肉量,同时测量患儿的身高、体质量、上臂围及肱三头肌皮褶厚度等人体学测量指标,计算儿科营养不良评估筛查工具评分,监测患儿的血清白蛋白值和血红蛋白值,以DSM-BIA法作为参照标准,探讨不同指标的评价效果。结果在诱导缓解期间,132例患儿中有69例的肌肉量低于正常值,检出率为52.3%(69/132),上臂围与DSM-BIA法测得的肌肉量的一致性最高且标准误最小(R2=0.520,SE=0.180);以上臂围营养状态分类患儿,营养状态正常患儿极重度粒细胞减少症的发生率为76.8%(24/32),较营养状态异常患儿92.1%(70/76)低,差异有统计学意义(χ^(2)=6.14,P=0.013)。结论ALL患儿在诱导缓解期营养不良比率高;人体学测量指标中,上臂围是一个能准确反映ALL诱导缓解期患儿营养状态的简便评估指标,建议临床护士以上臂围作为临床营养初筛指标。Objective To compare the nutritional evaluation methods and to analyze the clinical value of different nutritional evaluation indexes in acute lymphoblastic leukemia(ALL)pediatric patients during the stage of remission induction.Methods The clinical data of 132 ALL pediatric patients who were diagnosed and treated with remission induction in Shanghai Children′s Medical Center,School of Medicine,Shanghai Jiao Tong University from January 2018 to December 2020 were collected by convenient sampling method.The body composition was measured by direct segmental multifrequency bioelectrical impedance measurement(DSM-BIA),and the height,weight,upper arm circumference and triceps skinfold thickness were also measured.The Screening Tool for the Assessment of Malnutrition in Pediatrics scores were calculated.The serum albumin value and the hemoglobin value were monitored.Using DSM-BIA as the reference standard,the accuracy of different nutritional evaluation indexes was investigated and analyzed.Results During the stage of remission induction in ALL pediatric patients,there were 69 out of 132 children who had the muscle mass below normal.The muscle mass below normal was detected in 52.3%(69/132).And the upper arm circumference had the highest correlation and the minimal standard error with muscle mass measured by DSM-BIA(R2=0.520,SE=0.180).Grouped with nutritional status by the upper arm circumference,the children with normal nutritional status had lower incidence of very severe neutropenia 76.8%(24/32)than 92.1%(70/76)with abnormal nutritional status(χ^(2)=6.14,P=0.013).Conclusions During the stage of remission induction in ALL pediatric patients,the malnutrition rate is high.The upper arm circumference is a simple index which can accurately reflect the nutritional status of the ALL pediatric patients.It is suggested that the upper arm circumference should be used as the primary screening index of clinical nutrition by clinical nurses.

关 键 词：急性淋巴细胞白血病 营养评价 儿童 临床价值 

分 类 号：R733.71[医药卫生—肿瘤]