摘要
目的通过在儿童急性淋巴细胞白血病(ALL)患儿诱导治疗期给予肠内营养支持,观察该段时间内患儿营养学指标的变化及对化疗并发症的影响,并观察肠内营养制剂的安全性。方法选择2016年11月至2017年9月在北京儿童医院血液肿瘤中心的60例初诊ALL患儿为研究对象,采用简单随机化方法平行分为试验组和对照组,每组各30例。试验组在常规低脂饮食的基础上,给予高热卡、优质蛋白、高中链三酰甘油型肠内营养制剂,持续时间为ALL患儿诱导治疗期间,对照组则按常规给予低脂饮食。通过分析诱导化疗前(D0)、化疗第15天(D15)及化疗第33天(D33)的相关指标,了解2组患儿营养状态变化及对化疗并发症的影响。结果2组患儿体质量指数(BMI)及肱三头肌皮褶厚度在化疗前后无明显变化,差异均无统计学意义(均P>0.05),但试验组化疗后上臂围上升[治疗前:(15.80±2.63) cm,治疗后(16.27±2.57) cm],对照组较化疗前下降[化疗前:(17.19±3.71) cm,化疗后:(17.15±3.64) cm],差异均有统计学意义(均P<0.05)。化疗后2组总蛋白[试验组:(64.52±4.85) g/L,对照组:(61.97±4.65) g/L]均下降,与化疗前[试验组:(68.17±6.37) g/L,对照组:(68.08±5.14) g/L]比较差异均有统计学意义(均P<0.01);试验组化疗后总蛋白水平高于对照组,下降幅度较小,差异有统计学意义(P<0.05)。化疗后2组清蛋白[试验组:(42.45±4.32) g/L,对照组:(41.15±3.73) g/L]均上升,与化疗前[试验组:(39.54±3.26) g/L,对照组:(40.01±4.37) g/L]比较差异均有统计学意义(均P<0.05)。2组化疗后前清蛋白水平[试验组:(324.57±64.328) mg/L,对照组(293.07±69.09) mg/L]均上升,与化疗前比较差异均有统计学意义(均P<0.05);试验组化疗前前清蛋白水平低于对照组,化疗后反而高于对照组,2组前清蛋白比较差异均有统计学意义(均P<0.05)。试验组化疗后元素铁减低率低于对照组,但差异无统计学意义(P>0.05)。元素锌与对照组比较差异无统计学意义。ALL患儿化疗后中性粒细胞缺乏症发生率较高(37/60例,61.67%),试验组化疗后中性粒细胞缺乏症恢复情况优于对照组。化疗后试验组贫血程度轻于对照组,输血人次、人均输血次数均少于对照组(54人次比74人次,2.45次比3.08次),输注血制品人次少于对照组(78人次比101人次),但差异无统计学意义(P>0.05)。试验组化疗后肝损程度下降,对照组无明显变化。试验组初始活化部分凝血酶原时间(APTT)延长人数多于对照组(5例比3例),化疗后少于对照组(0例比1例)。试验组化疗期间发热人数少于对照组(6例比8例),平均发热时间短于对照组(2.8 d比4.1 d),但差异均无统计学意义(均P>0.05)。化疗过程中试验组发生胰腺炎0例,对照组发生胰腺炎1例。2组化疗D15、D33缓解率差异无统计学意义(P>0.05)。结论ALL患儿经初期诱导化疗后营养状态有所下降,采用高热卡、优质蛋白、高中链三酰甘油型肠内营养支持有助于维持患儿化疗初期的营养状态,肠内营养支持可提高血液系统对化疗的耐受性并减少并发症发生。
Objective To observe the changes in nutrition indicators and the effect on chemotherapy complications as well as the safety of enteral nutrition by way of providing enteral nutrition support for children with acute lymphoblastic leukemia (ALL) at the stage of induction chemotherapy. Methods From November 2016 to September 2017, 60 children with newly diagnosed ALL at the Hematology Oncology Center of Beijing Children′s Hospital were enrolled in this study.They were randomly divided into an experimental group and a control group, 30 cases for each group.The experimental group was given a high-calorie diet, high-quality protein, and high-medium-chain trigly-ceride enteral nutrition on the basis of a conventional low-fat diet, and the duration lasted the whole induction treatment of ALL children;while the control group was given a low-fat diet routinely.By analyzing relevant indicators before induction chemotherapy (D0), chemotherapy day 15 (D15), and after chemotherapy (D33), the changes in nutritional status and the effect on chemotherapy complications in 2 groups were investigated. Results There was no significant difference in the body mass index (BMI) and the thickness of triceps skinfold between 2 groups before and after chemotherapy (all P>0.05). The upper arm circumference increased after chemotherapy in the experimental group[before treatment:(15.80±2.63) cm, after treatment:(16.27±2.57) cm], while that of the control group decreased slightly[before chemotherapy:(17.19±3.71) cm, after chemotherapy:(17.15±3.64) cm], and the difference between 2 groups was statistically significant (P<0.05). After chemotherapy, the total protein levels in two groups decreased[the experimental group:(64.52±4.85) g/L, the control group:(61.97±4.65) g/L] which was significantly different from that before chemotherapy [the experimental group:(68.17±6.37) g/L, the control group:(68.08±5.14) g/L](P<0.01). The total protein level of the experimental group after chemotherapy was significant higher than that in the control group (P<0.05). Both albumin levels in 2 groups increased after chemotherapy [(42.45±4.32) g/L in the experimental group and (41.15±3.73) g/L in the control group], and there was a significant difference between 2 groups before chemotherapy [(39.54±3.26) g/L in the experimental group and (40.01±4.37) g/L in the control group](P<0.05). The level of prealbumin increased after chemotherapy in both groups [(324.57±64.328) mg/L in the experimental group and (293.07±69.09) mg/L in the control group] compared with that before chemotherapy [(121.10±35.13) mg/L in the experimental group and(131.20±52.77) mg/L in the control group]. The change was statistically significant (P<0.01). The albumin level in the experimental group before chemotherapy was lower than that in the control group after chemotherapy, but it was higher than that in the control group after chemotherapy.Protein differences were statistically significant (P<0.05). The reduction rate of elemental iron in the experimental group after chemotherapy was lower than that in the control group, but it was not statistically significant (P>0.05). Elemental zinc was not significantly different compared with the control group.The incidence of neutropenia after chemotherapy in ALL children was higher (37/60 cases, 61.67%). The recovery of neutropenia after chemotherapy in the experimental group was better than that in the control group.After chemotherapy, the severity of anemia in the experimental group was lighter than that in the control group.The amount of blood transfusion required and amount of transfusion per capita were less than those in the control group (54 person-times vs.74 person-times, 2.45 times vs.3.08 times). The total number of transfused blood products was less than that of the control group (78 person-times vs.101 person-times), but none of the findings above were statistically significant (all P>0.05). The degree of hepatic damage in the experimental group decreased after chemotherapy, but there was no significant change in the control group.The initial activated partial thromboplastin time(APTT) prolongation in the trial group was more than that in the control group (5 cases vs.3 cases), and less than the control group (0 case vs.1 case) after chemotherapy.The frequency of fever in the experimental group during chemotherapy was less than that in the control group (6 cases vs.8 cases), and the average time of fever was shorter than that in the control group (2.8 d vs.4.1 d). None of the above findings were statistically significant (all P>0.05). During the course of chemotherapy, 0 pancreatitis occurred in the experimental group, and 1 pancreatitis occurred in the control group.There was no difference in remission rates between 2 groups of chemotherapy for 15 days and chemotherapy for 33 days. Conclusions The nutritional status of children with ALL was reduced after initial induction chemotherapy.Enteral nutrition support was helpful to maintain the nutritional status for children at the initial stage of chemotherapy, high-calorie diet, high-quality protein, and high-medium-chain triglyceride enteral nutrition support improves blood system tolerance to chemotherapy and reduces chemotherapy complications.
作者
王超
栗达
林巍
张元元
范佳
于娇乐
张瑞东
吴颖
漆佩静
陆继冉
李静
林嘉衍
郑雪岭
闫洁
郑胡镛
Wang Chao;Li Da;Lin Wei;Zhang Yuanyuan;Fan Jia;Yu Jiaole;Zhang Ruidong;Wu Ying;Qi Peijing;Lu Jiran;Li Jing;Lin Jiayan;Zheng Xueling;Yan Jie;Zheng Huyong(Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China;Department of Nutrition, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2019年第17期1335-1339,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
国家科技重大专项(2017ZX09304029004)
北京市医院管理局临床医学发展专项(ZY201404)
北京市医院管理局登峰计划(DFL20151101)
首都卫生发展科研专项-重点攻关(首发2016-I-2091).
关键词
淋巴细胞白血病
急性
儿童
肠内营养支持
化疗并发症
Acute lymphoblastic leukemia
Child
Enteral nutrition support
Chemotherapy complication
