生物电阻抗分析的相位角可作为预测和评估儿童及青少年造血干细胞移植后营养状态的工具。
Phase angle from BIA as a prognostic and nutritional status tool for children and adolescents undergoing hematopoietic stem cell transplantation.
机构信息
Department of Nutrition, Federal University of Paraná, Av. Lothário Meissner 3400, Jardim Botânico, 80210-170 Curitiba, Paraná, Brazil.
出版信息
Clin Nutr. 2013 Jun;32(3):420-5. doi: 10.1016/j.clnu.2012.09.003. Epub 2012 Oct 12.
BACKGROUND & AIMS: The phase angle (PA) has been considered a prognostic and nutritional status indicator in several clinical situations considering its use as a body cell mass estimate value. The aim of this study was to evaluate the association between PA and other methods of nutritional assessment, as well as its prognostic value for children and adolescents undergoing hematopoietic stem cell transplantation (HSCT).
METHODS
The nutritional status of 67 patients and 35 controls was assessed by bioelectric impedance analysis and anthropometric measurements. The phase angle was calculated and expressed in degrees and standardized (SPA) according to reference values. The Kaplan-Meier method was used to calculate survival and Kappa coefficient to determine the concordance between the SPA and other parameters of nutritional assessment. The correlation was established by using Pearson's correlation analysis.
RESULTS
SPA progressively decreased during the treatment. The agreement between SPA and the diagnosis of malnutrition was moderate to %ideal weight, %TSF and %AMC and weak for BMI and weight/age z-score. Patients who had severe weight loss after transplantation had lower levels of SPA as compared to the group that did not lose weight (p < 0.001). Patients who developed chronic graft-versus-host disease had lower levels of SPA (p = 0.02), as well as patients who had been using corticosteroids during the post-transplant phase (p = 0.03). In this case, there was an inverse correlation between drug dose and SPA (p = 0.01). Patients with SPA ≤ 0 SD had a lower survival time as compared to the group of patients with SPA > 0 SD (p = 0.02) and showed an increased risk of death of 5.1as compared to the other group (95% CI: 1.41-18.94).
CONCLUSION
The present study suggests that SPA could be useful as an indicator of survival and nutritional status for patients undergoing HSCT.
背景与目的
相位角（PA）已被认为是几种临床情况下的预后和营养状况指标，因为它可作为身体细胞质量估计值。本研究的目的是评估 PA 与其他营养评估方法之间的关系，以及其对接受造血干细胞移植（HSCT）的儿童和青少年的预后价值。
方法
通过生物电阻抗分析和人体测量法评估 67 例患者和 35 例对照者的营养状况。计算相位角并以度数表示，并根据参考值进行标准化（SPA）。使用 Kaplan-Meier 法计算生存，使用 Kappa 系数确定 SPA 与其他营养评估参数之间的一致性。使用 Pearson 相关分析建立相关性。
结果
SPA 在治疗过程中逐渐降低。SPA 与营养不良诊断的一致性为中度至%理想体重、%TSF 和%AMC，与 BMI 和体重/年龄 z 评分的一致性为弱。与未减重的患者相比，移植后发生严重体重减轻的患者 SPA 水平较低（p<0.001）。发生慢性移植物抗宿主病的患者 SPA 水平较低（p=0.02），以及在移植后阶段使用皮质类固醇的患者（p=0.03）。在这种情况下，药物剂量与 SPA 呈负相关（p=0.01）。SPA≤0 SD 的患者的生存时间低于 SPA>0 SD 的患者（p=0.02），与其他组相比，死亡风险增加了 5.1 倍（95%CI：1.41-18.94）。
结论
本研究表明，SPA 可作为接受 HSCT 患者的生存和营养状况的指标。
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