肠内与肠外营养支持在异基因造血干细胞移植中的应用。
Enteral versus parenteral nutritional support in allogeneic haematopoietic stem-cell transplantation.
机构信息
CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000 Clermont-Ferrand, France.
CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA7283, CIC501, BP 10448, F-63000 Clermont-Ferrand, France.
出版信息
Clin Nutr. 2014 Jun;33(3):533-8. doi: 10.1016/j.clnu.2013.07.012. Epub 2013 Jul 31.
BACKGROUND
Allogeneic haematopoietic stem-cell transplantation (allo-HSCT) is associated with frequent and severe malnutrition, which may contribute to transplant-related morbidity. While both enteral nutrition (EN) via a nasogastric tube and parenteral nutrition (PN) are effective, it remains unclear what is the optimal method of nutritional support.
AIMS
We propose to compare the impact of EN versus PN on early outcome after allo-HSCT.
METHODS
We evaluated the effect of initial nutritional support with EN versus PN on early outcome in 56 patients who required nutritional support after first allo-HSCT for haematological malignancies in our centre. Patients were offered EN but could decline and chose to be treated by PN.
RESULTS
Twenty patients received myeloablative conditioning and 36 received reduced-intensity conditioning. Twenty-eight patients received EN and 28 received PN. Compared with PN, EN was associated with a lower median duration of fever (2 versus 5 days; p < 0.01), a reduced need for empirical antifungal therapy (7 versus 17 patients; p < 0.01), a lower rate of central venous catheter replacement (9 versus 3 patients; p = 0.051) and a lower rate of transfer to intensive care (2 versus 8 patients; p = 0.036). The early death rate (<100 days) was the same in both groups (14%).
CONCLUSIONS
Compared with PN, EN was associated with a lower risk of infection in allo-HSCT, without an increase in the incidence of graft-versus-host disease.
背景
异基因造血干细胞移植（allo-HSCT）常伴有严重的营养不良，这可能导致与移植相关的发病率增加。肠内营养（EN）和肠外营养（PN）均有效，但尚不清楚哪种方法是最佳的营养支持方法。
目的
我们旨在比较 EN 与 PN 对 allo-HSCT 后早期结局的影响。
方法
我们评估了在我们中心首次接受allo-HSCT 治疗血液系统恶性肿瘤的 56 例需要营养支持的患者中，初始 EN 与 PN 营养支持对早期结局的影响。患者可选择接受 EN 或 PN，但有拒绝的权利。
结果
20 例患者接受了清髓性预处理，36 例患者接受了强度降低预处理。28 例患者接受了 EN，28 例患者接受了 PN。与 PN 相比，EN 与较低的中位发热持续时间（2 天与 5 天；p < 0.01）、较低的经验性抗真菌治疗需求（7 例与 17 例；p < 0.01）、较低的中心静脉导管更换率（9 例与 3 例；p = 0.051）和较低的转入重症监护病房率（2 例与 8 例；p = 0.036）相关。两组的早期死亡率（<100 天）相同（14%）。
结论
与 PN 相比，allo-HSCT 中，EN 与感染风险降低相关，而移植物抗宿主病的发生率没有增加。
Zotero 插件