Baumgartner A, Bargetzi A, Zueger N, Bargetzi M, Medinger M, Bounoure L, Gomes F, Stanga Z, Mueller B, Schuetz P
Aarau and Medical Faculty of the University of Basel, Division of Endocrinology/Metabolism/Clinical Nutrition, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland.
Division of Oncology/Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Bone Marrow Transplant. 2017 Apr;52(4):506-513. doi: 10.1038/bmt.2016.310. Epub 2017 Jan 9.
In 2009, the American Society of Parenteral and Enteral Nutrition and its European counterpart (Euopean Society for Parenteral and Enteral Nutrition) published guidelines regarding nutritional support of patients with hematologic stem cell transplantation. Our aim was to do an up-to-date literature review regarding benefit of nutritional interventions and treatment recommendations. We searched MEDLINE, EMBASE and Cochrane Library for interventional and observational clinical studies. We extracted data based on a predefined case report form and assessed bias. Out of 459 potential abstracts, 13 studies of mostly moderate quality with a total of 18 167 patients were included. Two very large trials reported negative associations of malnutrition and survival, transplant-related mortality and relapse risk. Some trials found enteral nutrition (EN) to be as effective as parenteral nutrition (PN) with lower complication rates. In addition, EN was associated with better survival, less acute GvHD and faster neutrophil recovery. A neutropenic diet was not superior regarding overall survival, but in contrast resulted in higher infection risk. Current moderate quality studies show negative associations of malnutrition and clinical outcomes, with EN being superior to PN. There was no benefit of neutropenic diets. Large, randomized controlled studies are needed to better understand optimal nutritional support in this patient population.
2009年，美国肠外肠内营养学会及其欧洲同行（欧洲肠外肠内营养学会）发布了关于血液系统干细胞移植患者营养支持的指南。我们的目的是对营养干预的益处和治疗建议进行最新的文献综述。我们在MEDLINE、EMBASE和Cochrane图书馆中检索了干预性和观察性临床研究。我们根据预先定义的病例报告表提取数据并评估偏倚。在459篇潜在摘要中，纳入了13项质量大多为中等的研究，共18167名患者。两项非常大型的试验报告了营养不良与生存率、移植相关死亡率和复发风险之间的负相关关系。一些试验发现肠内营养（EN）与肠外营养（PN）效果相当，但并发症发生率更低。此外，EN与更好的生存率、更少的急性移植物抗宿主病（GvHD）和更快的中性粒细胞恢复相关。就总生存率而言，粒细胞缺乏饮食并无优势，反而导致更高的感染风险。目前质量中等的研究表明营养不良与临床结局之间存在负相关关系，EN优于PN。粒细胞缺乏饮食并无益处。需要开展大型随机对照研究，以更好地了解该患者群体的最佳营养支持。
