Muscaritoli M, Conversano L, Cangiano C, Capria S, Laviano A, Arcese W, Rossi Fanelli F
Department of Clinical Medicine, University of Rome La Sapienza, Italy.
Nutrition. 1995 Sep-Oct;11(5):433-6.
The validity of biochemical indices routinely used for nutritional assessment was evaluated in patients undergoing allogeneic bone marrow transplantation for hematologic malignancies. Sixteen patients received total parenteral nutrition (TPN) for 15 days (35 kcal kg.body wt-1.day-1; 1.4 g amino acid.kg body wt-1.day-1) starting 1 day after transplantation. Nutritional status was evaluated before and after the TPN period by determining anthropometric (body weight, triceps skinfold thickness, and midarm circumference) and biochemical (transferrin, prealbumin, ceruloplasmin, and C3c) indices. Anthropometric indices, which were within the normal range before TPN, were not changed on day 15; transferrin and prealbumin concentrations significantly (p = 0.03) decreased whereas ceruloplasmin and C3c significantly (p = 0.03) increased. The levels of acute-phase proteins (alpha-1-acid glycoprotein, alpha-1-antitrypsin, and C-reactive protein), determined in 8 of the 16 patients at the same time intervals, were increased after 15 days of TPN and were significantly inversely correlated with transferrin and prealbumin. On the basis of these data, it appears that biochemical indices are not sufficiently reliable in the nutritional assessment of bone marrow transplantation patients because the levels of these substances are markedly affected by the acute-phase response secondary to febrile episodes and graft-versus-host disease, which frequently complicate transplantation.
对用于血液系统恶性肿瘤异基因骨髓移植患者营养评估的常规生化指标的有效性进行了评估。16例患者在移植后1天开始接受15天的全胃肠外营养（TPN）（35千卡·千克体重⁻¹·天⁻¹；1.4克氨基酸·千克体重⁻¹·天⁻¹）。通过测定人体测量学指标（体重、三头肌皮褶厚度和上臂中部周长）和生化指标（转铁蛋白、前白蛋白、铜蓝蛋白和C3c）评估TPN期间前后的营养状况。TPN前在正常范围内的人体测量学指标在第15天时未发生变化；转铁蛋白和前白蛋白浓度显著（p = 0.03）降低，而铜蓝蛋白和C3c显著（p = 0.03）升高。在相同时间间隔对16例患者中的8例测定的急性期蛋白（α-1-酸性糖蛋白、α-1-抗胰蛋白酶和C反应蛋白）水平在TPN 15天后升高，且与转铁蛋白和前白蛋白显著负相关。基于这些数据，生化指标在骨髓移植患者的营养评估中似乎不够可靠，因为这些物质的水平受到发热发作和移植物抗宿主病继发的急性期反应的显著影响，而发热发作和移植物抗宿主病在移植中经常出现并发症。
