骨髓移植患儿移植前后饮食摄入的改变

目的分析骨髓移植患儿移植期间营养摄入及营养状况的改变，评估营养干预的重要性。方法以2012年1月至2012年11月在上海交通大学医学院附属上海儿童医学中心血液肿瘤科行骨髓移植的共计65名患儿为研究对象。以预处理前收集的患儿资料为基线值。预处理开始后至移植后30d每周2次、移植后30-100d每周1次收集患儿营养相关资料，并对患儿日常营养摄入进行膳食分析。在相应时间点收集患儿24h小便行定氮分析。结果患儿总能量和各项宏量营养素口服摄入基线值分别为：总能量（5844．9±2490．4）kJ/d，蛋白质（56．4±28．6）g/d，脂肪（49．7±38．9）g／d，碳水化合物（190．9±91．1）g/d。随着移植预处理开始，各项摄入均明显减少（P均=0．000）。移植后恢复期，患儿能量摄人自第6周开始与基线值差异无统计学意义，蛋白质自第13周开始与基线水平差异无统计学意义，碳水化合物和脂肪摄入分别自第4周和第6周起与基线水平差异无统计学意义。移植前患儿尿氮排出量为（3．9±2．4）g/d，进行预处理后尿氮量达到（16．7±11．0）g／d，显著高于基线尿氮量（P=0．000）。患儿移植后第1周的体重（P=0．000）、三头肌皮褶厚度（P=0．003）、中上臂围（P=0．000）、血清白蛋白（P=0．000）、前白蛋白（P=0．000）均显著低于基线值；移植后第9周的去脂百分比（P=0．010）、肌肉百分比（P=0．001）和蛋白质百分比（P=0．000）显著低于基线值，体脂百分比显著高于基线值（P=0．000）。结论骨髓移植患儿早期即有营养摄入量的改变，在移植恢复期逐渐恢复，其中蛋白质摄入恢复最慢，可能是影响患儿血清蛋白水平的重要因素。因此，骨髓移植患儿需要更为详细的营养指导，尽量以口服摄入满足营养需求，必要时可提供高蛋白营养配方。

Changeof dietary intake before and after hematopoietic stem cell transplantation in pediatric patients

Objective To explore the change of dietary intake and nutritional status before and after hematopoietic stem cell transplantation （HSCT） in pediatric patients to assess the importance of nutritional interventions. Methods In this observational cohort study, 65 children undergoing HSCT between January 2012 and November 2012 in the Department of Hematology and Oncology, Shanghai Children＇s Medical Center were enrolled. The data collected before preconditioning were considered as the baseline data. We also collected data twice a week between preconditioning and 30 days after HSCT, and once a week from 30 days to 100 days after HSCT. Dietary analysis and urea nitrogen analysis were conducted in parallel. Results The baseline level of energy intake was （5 844. 9 ±2 490. 4） kJ/d, protein intake was （56. 4 ±28. 6） g/d, fat intake was （49.7 ±38.9） g/d, and carbohydrate intake was （190. 9 ±91.1 ） g/d. With the hematopoietic reconstruction, the oral nutrients intake significantly decreased compared with the baseline levels （all P =0. 000）. During the recovery period after HSCT, the energy intake showed no significant difference when compared with the baseline level in the 6th postoperative week, protein in the 13th week, carbohydrate in the 4th week, and fat in the 6th week. The urine nitrogen was （3.9 ± 2. 4） g/d before HSCT, which increased to （16.7 ± 11.0） g/d after preconditioning （P=0.000）. In the 1st postoperative week, the weight （P = 0. 000）, triceps skin fold thickness （ P = 0. 003 ）, mid-upper arm circumference （ P = 0. 000）, serum albumin （ P = 0. 000） and prealbumin （ P = 0. 000） of the patients all significantly decreased compared with the baseline levels. In the 9th postoperative week, the fat-free body weight percentage （P = 0. 010）, muscle percentage （P =0. 001 ） and protein percentage （P = 0. 000） were significantly lower than the baseline levels, while the body fat percentage was higher than the baseline level （P = 0. 002）. Conclusions Children undergoing HSCT exhibit a marked reduction in nutrient intakes at the early stage of HSCT, which may gradually return normal during the recovery period. This process may be slow, especially for the protein, and therefore may affect the serum protein level in these pediatric patients. Thus, more careful nutrition guidance is necessary during HSCT for pediatric patients, emphasizing oral nutrients intakes, and high protein dietary or formula may be helpful.