Schulte C, Reinhardt W, Beelen D, Mann K, Schaefer U
Department of Medicine, University of Essen, Germany.
Bone Marrow Transplant. 1998 Dec;22(12):1171-8. doi: 10.1038/sj.bmt.1701502.
Bone marrow transplantation is known to be associated with considerable morbidity and mortality. The aim of this study was to determine the influence of nutritional status and development of sick euthyroid syndrome as prognostic factors for outcome after BMT. In 100 patients who underwent transplantation the following parameters were assessed before and at day 14 and 28 after transplantation: anthropometric data (body weight, body mass index, body composition, grip strength), rapid turnover proteins transferrin and prealbumin, T4, T3, free T4, reverse T3, thyroid-stimulating hormone and thyroglobulin. Following bone marrow transplantation, 22 patients died in the short-term follow-up (group A) before day 140 after BMT, 21 patients died during further follow-up between days 140 and 365 (group B) and 57 patients survived longer than 365 days (group C). All patients experienced a significant decrease of transferrin and T3, accompanied by an increase of rT3 and rT3/T3 ratio at day 14 after BMT. At day 28 after BMT, patients in group C showed recovery from these changes with an increase of transferrin and a fall in rT3 and the rT3/T3-ratio, which was not seen in patients who died during further follow-up (groups A and B). The observed changes were independent of other prognostically relevant factors (type of disease, HLA-match, immunosuppression). Impaired nutritional status and development of a sick euthyroid syndrome, without tendency to recovery, are associated with a higher probability of fatal outcome after bone marrow transplantation and have prognostic relevance in this group of patients.
已知骨髓移植会伴随着相当高的发病率和死亡率。本研究的目的是确定营养状况和低甲状腺素病态综合征的发展作为骨髓移植后预后因素的影响。对100例接受移植的患者在移植前以及移植后第14天和第28天评估了以下参数：人体测量数据（体重、体重指数、身体成分、握力）、快速周转蛋白转铁蛋白和前白蛋白、T4、T3、游离T4、反T3、促甲状腺激素和甲状腺球蛋白。骨髓移植后，22例患者在骨髓移植后140天内的短期随访中死亡（A组），21例患者在140天至365天的进一步随访中死亡（B组），57例患者存活超过365天（C组）。所有患者在骨髓移植后第14天转铁蛋白和T3均显著下降，同时rT3和rT3/T3比值升高。骨髓移植后第28天，C组患者这些变化出现恢复，转铁蛋白增加，rT3和rT3/T3比值下降，而在进一步随访中死亡的患者（A组和B组）中未观察到这种情况。观察到的变化独立于其他预后相关因素（疾病类型、HLA匹配、免疫抑制）。营养状况受损和低甲状腺素病态综合征的发展且无恢复趋势，与骨髓移植后致命结局的较高概率相关，并且在这组患者中具有预后意义。
