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异基因干细胞移植后的营养支持与临床结局

Nutrition support and clinical outcomes following allogeneic stem cell transplantation.

作者信息

Andersen Sarah, Xu Jiani, Llewellyn Stacey, Kennedy Glen, Bauer Judy

机构信息

Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.

School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4072, Australia.

出版信息

Bone Marrow Transplant. 2023 Oct;58(10):1137-1142. doi: 10.1038/s41409-023-02080-7. Epub 2023 Aug 4.

DOI:10.1038/s41409-023-02080-7
PMID:37542189
Abstract

Nutrition support is frequently required post allogeneic stem cell transplantation (SCT) and while there is some evidence on the benefits of enteral nutrition (EN), parenteral nutrition (PN) is widely used in practice. The study aimed to examine the impact of EN versus PN on early outcomes following SCT. All patients who underwent allogeneic SCT over 2.5 years were included in the analysis. Data was retrospectively collected on mode of nutrition support with clinical outcome data obtained from an existing database. Clinical outcomes were compared between groups by logistic, poisson and negative binomial regression, with adjustment for baseline confounders as appropriate. Patients who received EN then changed to PN had a longer length of hospital stay compared to those who received EN only (IR 1.24, 95% CI: 1.11-1.38, p < 0.001). Compared to those who received EN only, patients who received EN that changed to PN or PN only had a longer time to neutrophil engraftment (IR 1.11, 95% CI: 1.02-1.20, p = 0.016 and IR 1.16, 95% CI: 1.03-1.30, p = 0.017) and platelet engraftment (IR 1.20, 95% CI 1.08-1.33, p < 0.001 and IR 1.24, 95% CI 1.08-1.42, p = 0.002). Enteral nutrition should be first line nutritional support for patients undergoing allogeneic SCT.

摘要

异基因造血干细胞移植(SCT)后常常需要营养支持,虽然有一些证据表明肠内营养(EN)有益,但肠外营养(PN)在实际中被广泛使用。该研究旨在探讨EN与PN对SCT后早期结局的影响。分析纳入了所有在2.5年期间接受异基因SCT的患者。通过回顾性收集营养支持方式的数据,并从现有数据库中获取临床结局数据。通过逻辑回归、泊松回归和负二项回归对组间临床结局进行比较,并酌情对基线混杂因素进行调整。接受EN后改为PN的患者与仅接受EN的患者相比,住院时间更长(发病率比1.24,95%置信区间:1.11 - 1.38,p < 0.001)。与仅接受EN者相比,接受EN后改为PN或仅接受PN的患者中性粒细胞植入时间更长(发病率比1.11,95%置信区间:1.02 - 1.20,p = 0.016;发病率比1.16,95%置信区间:1.03 - 1.30,p = 0.017),血小板植入时间也更长(发病率比1.20,95%置信区间1.08 - 1.33,p < 0.001;发病率比1.24,95%置信区间1.08 - 1.42,p = 0.002)。肠内营养应作为接受异基因SCT患者的一线营养支持。

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Br J Haematol. 2020 Feb;188(4):570-581. doi: 10.1111/bjh.16218. Epub 2019 Oct 14.
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