异基因造血干细胞移植患儿移植后饮食变化影响因素分析  

Analysis of factors influencing dietary changes in children undergoing allogeneic hematopoietic stem cell transplantation

作　　者：颜莓 唐维兵[1] 方拥军[2] 黄婕[2] 朱亭 付金玉 夏晓娜 刘长伟[1] 万园园 潘键 YAN Mei;TANG Weibing;FANG Yongjun;HUANG Jie;ZHU Ting;FU Jinyu;XIA Xiaona;LIU Changwei;WAN Yuanyuan;PAN Jian(Department of Clinical Nutrition,2.Department of Hematology and Oncology,Children’s Hospital of Nanjing Medical University,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京医科大学附属儿童医院临床营养科,江苏南京210008 [2]南京医科大学附属儿童医院血液肿瘤科,江苏南京210008

出　　处：《临床儿科杂志》2024年第11期955-961,共7页Journal of Clinical Pediatrics

摘　　要：目的研究异基因造血干细胞移植(alloHSCT)患儿移植前后饮食摄入量变化相关影响因素,并分析饮食摄入量与住院期间临床结局相关性。方法对2018年4月至2023年8月住院治疗的144例接受alloHSCT患儿的临床资料进行回顾性分析。患儿预处理前,移植后0 d、14 d、30 d行饮食摄入调查及营养状况分析。采用广义估计方程分析饮食摄入量变化影响因素,Spearman相关性分析与临床结局相关性。结果患儿预处理前饮食摄入热量为1315.20(922.15~1600.88)kcal/d,占推荐目标热量百分比为90.85%(80.10%~103.00%),移植0 d及移植14 d,热量分别下降为344.95(66.85~532.50)kcal/d,377.90(108.43~689.40)kcal/d,饮食摄入热量占推荐目标热量百分比分别下降为25.50%(4.20%~46.25%),23.50%(7.21%~50.08%),三大营养素摄入均显著减少,移植30 d饮食摄入量及三大营养素上升,饮食摄入热量上升至721.45(285.75~1252.25)kcal/d,占推荐目标热量百分比58.00%(21.50%~81.92%)(P均<0.001)。广义估计方程分析显示年龄(P<0.001)、口腔黏膜炎(P=0.023)、Ⅱ~Ⅳ度急性移植物抗宿主病(aGVHD,P<0.001)、发热时间(P=0.005)、移植前STAMP筛查高风险(P=0.026)均与饮食摄入变化显著相关。与饮食摄入无关的因素包括alloHSCT前营养状况、疾病诊断、移植类型等。alloHSCT后患儿饮食摄入与年龄体质指数Z评分(BMI-Z)值下降、住院时间、住院费用负相关,r分别为(-0.516,-0.238,-0.465),P值分别为(<0.001,0.011,<0.001)。结论移植后,不同营养状况、疾病诊断、移植类型的患儿的饮食摄入热量及三大营养素均显著下降,饮食摄入量与住院期间不良临床结局负相关。应关注移植后所有患儿饮食及营养素摄入变化,特别是年龄越大、STAMP高风险,或是患有口腔黏膜炎、Ⅱ~Ⅳ度aGVHD、感染重的患儿,及时提供有效营养干预,以助于改善临床结局。Objective To investigate influencing factors of dietary changes in children undergoing allogeneic hematopoietic stem cell transplantation(alloHSCT)and to analyze the correlation between reduced dietary intakes and clinical outcomes during hospitalization.Methods We collected data of 144 children undergoing alloHSCT from hospital between April 2018 and August 2023.Dietary intakes and nutritional status were assessed prior to transplantation and on day 0,+14 and+30 after alloHSCT.The relationship between post-transplant clinical outcomes and dietary intakes was analyzed using Spearman correlation analysis.Results The baseline energy intake was 1315.20(922.15-1600.88)kcal/d,representing 90.85%(80.10%-103.00%)of the dietary reference intakes(DRIs).On day 0,+14 of transplantation,the calorie intake decreased to 344.95(66.85-532.50)kcal/d and 377.90(108.43-689.40)kcal/d,the percentage of dietary caloric intake in DRIs decreased to 25.50%(4.20%-46.25%)and 23.50%(7.21%-50.08%),respectively.The intake of macronutrient also significantly decreased.By day+30 post-transplantation,dietary intake and macronutrient increased,with dietary intake increased to 721.45(285.75-1252.25)kcal/d,accounting for 58.00%(21.50%-81.92%)of DRIs(P<0.001).The generalized estimation equation analysis showed that age(P<0.001),oral mucositis(P=0.023),Ⅱ-Ⅳacute graft versus host disease(aGVHD,P<0.001),length of cumulative febrile episodes(P=0.005),and a high risk of STAMP before transplantation(P=0.026)were significant influencing factors for changes in dietary intake.The negative correlation between dietary intake of children undergoing alloHSCT and decrease in BMI-Z,length of hospital stay,and inpatient treatment costs was observed,with r values of(-0.516,-0.238,-0.465)and P values of(<0.001,0.011,<0.001)respectively.Conclusion After alloHSCT,dietary intake and macronutrient of children with varying nutritional status,disease diagnosis,and transplant types significantly decreased.This reduction in dietary intake was associated with adverse clin

关 键 词：异基因造血干细胞移植 膳食调查 营养风险筛查 营养不良 

分 类 号：R457.7[医药卫生—治疗学] R72[医药卫生—临床医学]