Aquino V M, Harvey A R, Garvin J H, Godder K T, Nieder M L, Adams R H, Jackson G B, Sandler E S
Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA.
Bone Marrow Transplant. 2005 Oct;36(7):611-6. doi: 10.1038/sj.bmt.1705084.
Severe mucositis is a common cause of morbidity in hematopoietic stem cell transplant (HSCT) recipients. Glutamine has been shown to reduce mucositis in children receiving chemotherapy. Patients were randomized in a double-blind manner to receive glutamine or glycine at a dose of 2 g/m(2)/dose (maximum dose 4 g) twice daily until 28 days post transplant or discharge if sooner. Mucositis was graded by use of a modified Walsh scale. A total of 120 children were evaluable: 57 children received glutamine and 63 received glycine. The mean mucositis score was 3.0+/-0.3 vs 3.9+/-0.4 (P=0.07) in the glutamine and glycine groups, respectively. The glutamine group demonstrated a reduction in mean number of days of intravenous narcotics use (12.1+/-1.5 vs 19.3+/-2.8 in the glycine group, P=0.03) and total parenteral nutrition (17.3+/-1.7 vs 27.3+/-3.6 in glycine group, P=0.01). There was no statistically significant difference in toxicity between the two groups. Glutamine appears to be safe and beneficial in reducing the severity of mucositis. Strong consideration should be given to include oral glutamine supplementation as a routine part of supportive care of SCT patients.
严重黏膜炎是造血干细胞移植（HSCT）受者发病的常见原因。已证明谷氨酰胺可减轻接受化疗儿童的黏膜炎。患者被双盲随机分组，接受剂量为2 g/m²/次（最大剂量4 g）的谷氨酰胺或甘氨酸，每日两次，直至移植后28天或更早出院。使用改良的沃尔什量表对黏膜炎进行分级。共有120名儿童可进行评估：57名儿童接受谷氨酰胺，63名接受甘氨酸。谷氨酰胺组和甘氨酸组的平均黏膜炎评分分别为3.0±0.3和3.9±0.4（P = 0.07）。谷氨酰胺组静脉使用麻醉剂的平均天数减少（甘氨酸组为19.3±2.8天，谷氨酰胺组为12.1±1.5天，P = 0.03），全胃肠外营养天数也减少（甘氨酸组为27.3±3.6天，谷氨酰胺组为17.3±1.7天，P = 0.01）。两组之间的毒性无统计学显著差异。谷氨酰胺在减轻黏膜炎严重程度方面似乎是安全且有益的。应强烈考虑将口服补充谷氨酰胺作为SCT患者支持治疗的常规组成部分。
