造血干细胞移植患者肠外营养支持的临床观察

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。

Clinical observation of parenteral nutrition support in patients undergoing hematopoietic stem cell transplantation

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 struetolipid 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 statisticalty 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.