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异基因造血细胞移植成人的营养状况及其影响因素的纵向随访。

Longitudinal follow-up of nutritional status and its influencing factors in adults undergoing allogeneic hematopoietic cell transplantation.

机构信息

Department of Haematology/Oncology, Section of Nutrition, Albert Ludwigs-University Medical Center Freiburg, Freiburg, Germany.

出版信息

Bone Marrow Transplant. 2013 Mar;48(3):446-51. doi: 10.1038/bmt.2012.158. Epub 2012 Aug 27.

DOI:10.1038/bmt.2012.158
PMID:22922406
Abstract

There are few longitudinal data on nutritional status and body composition of patients undergoing allogeneic hematopoietic cell transplantation (alloHCT). We assessed nutritional status of 105 patients before alloHCT and its course during the early post-transplant period to day +30 and day +100 via weight history, body mass index (BMI) normalized for gender and age, Subjective Global Assessment, phase angle normalized for gender, age, and BMI, and fat-free and body fat masses. Furthermore, we present a multivariate regression model investigating the impact of factors on body weight. At admission, 23.8% reported significant weight losses (>5%) in the previous 6 months, and we noted 31.5% with abnormal age- and sex-adjusted BMI values (10th, 90th percentiles). BMI decreased significantly (P<0.0001) in both periods by 11% in total, meaning a weight loss of 8.6±5.7 kg. Simultaneously, the patients experienced significant losses (P<0.0001) of both fat-free and body fat masses. Multivariate regression model revealed clinically relevant acute GVHD (parameter estimate 1.43; P=0.02) and moderate/severe anorexia (parameter estimate 1.07; P=0.058) as independent factors influencing early weight loss. In conclusion, our results show a significant deterioration in nutritional status during the early post-transplant period. Predominant alloHCT-associated complications such as anorexia and acute GVHD became evident as significant factors influencing nutritional status.

摘要

在接受异基因造血细胞移植(alloHCT)的患者中,很少有关于营养状况和身体成分的纵向数据。我们通过体重史、性别和年龄标准化的体重指数(BMI)、主观整体评估、性别、年龄和 BMI 标准化的相位角以及无脂肪和体脂肪量来评估 105 例 alloHCT 前患者的营养状况及其在移植后早期(+30 天和+100 天)的过程。此外,我们提出了一个多元回归模型,研究影响体重的因素。入院时,23.8%的患者报告在过去 6 个月内体重明显下降(>5%),我们发现 31.5%的患者存在异常的年龄和性别调整后的 BMI 值(<第 10 百分位,>第 90 百分位)。BMI 在两个时期均显著下降(P<0.0001),总降幅为 11%,意味着体重减轻了 8.6±5.7kg。同时,患者的无脂肪和体脂肪量也出现了显著下降(P<0.0001)。多元回归模型显示,临床相关的急性移植物抗宿主病(参数估计值 1.43;P=0.02)和中度/重度厌食症(参数估计值 1.07;P=0.058)是影响早期体重减轻的独立因素。总之,我们的结果显示,移植后早期营养状况明显恶化。以厌食症和急性移植物抗宿主病为主的 alloHCT 相关并发症是影响营养状况的重要因素。

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