Merritt R J, Kalsch M, Roux L D, Ashley-Mills J, Siegel S S
JPEN J Parenter Enteral Nutr. 1985 May-Jun;9(3):303-6. doi: 10.1177/0148607185009003303.
Nutritional status was evaluated on 210 occasions in 90 pediatric oncology inpatients during a 7-month period; 39 had solid tumors and 51 leukemia. Ages ranged from 3 months to 20 yr. Nutritional parameters were defined as normal, "at risk," or "probably malnourished." Fifty-seven and 29% of assessments revealed at least one parameter "at risk" or "probably malnourished," respectively. Prognosis was negatively related to the number of abnormal nutritional parameters. Serum albumin was most frequently abnormal. However, on most occasions, hypoalbuminemia was associated with weight/height, arm muscle area, and triceps skinfold measurements in the normal range. In order to further identify determinants of serum albumin, we analyzed dietary, chemotherapy, and temperature data in 10 prospectively studied leukemia patients, half of whom received parenteral nutrition. In these patients there was little relationship of serum albumin to chemotherapy or dietary intake. In all of these patients, especially those receiving total parenteral nutrition, low serum albumin was highly associated with fever (p less than 0.0005). We concluded that febrile illness is an important determinant of abnormal serum albumin concentrations. In pediatric cancer patients, abnormal serum albumin may more often reflect the acute metabolic response to fever and infection than depletion of body mass.
在7个月的时间里，对90名儿科肿瘤住院患者进行了210次营养状况评估；其中39例患有实体瘤，51例患有白血病。年龄范围从3个月到20岁。营养参数被定义为正常、“有风险”或“可能营养不良”。分别有57%和29%的评估显示至少有一项参数“有风险”或“可能营养不良”。预后与异常营养参数的数量呈负相关。血清白蛋白最常出现异常。然而，在大多数情况下，低白蛋白血症与体重/身高、上臂肌肉面积和三头肌皮褶测量值处于正常范围相关。为了进一步确定血清白蛋白的决定因素，我们分析了10例前瞻性研究的白血病患者的饮食、化疗和体温数据，其中一半患者接受肠外营养。在这些患者中，血清白蛋白与化疗或饮食摄入量几乎没有关系。在所有这些患者中，尤其是接受全肠外营养的患者，低血清白蛋白与发热高度相关（p<0.0005）。我们得出结论，发热性疾病是血清白蛋白浓度异常的一个重要决定因素。在儿科癌症患者中，血清白蛋白异常可能更多地反映了对发热和感染的急性代谢反应，而不是体重的消耗。
