首页|移植前骨骼肌质量对异基因造血干细胞移植早期结果的影响研究

移植前骨骼肌质量对异基因造血干细胞移植早期结果的影响研究

Effect of Pre-transplant Skeletal Muscle Mass on Early Outcome of Allogeneic Hematopoietic Stem Cell Transplantation

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背景 异基因造血干细胞移植是治疗恶性血液病的有效手段,营养不良是常见并发症并对预后产生负性影响.已有研究证实肌肉量较白蛋白等血生化指标能更早反映患者的营养状况,而移植前骨骼肌质量(SMM)对移植早期相关并发症的影响目前尚不明确.目的 探讨移植前SMM对异基因造血干细胞移植早期结果的影响,为实施营养干预及改善预后提供临床依据.方法 选择 2022 年 1-10 月在陆军军医大学新桥医院血液病医学中心接受异基因造血干细胞移植的77例白血病患者为研究对象,采用生物电阻抗法评估SMM,根据SMM分为正常SMM组(36例)和低SMM组(41例),收集患者基线资料,包括个人信息和临床资料等,采用SPSS 23.0软件比较两组患者移植早期(移植后 30 d内)口腔黏膜炎情况、消化道症状、感染及造血重建时间等.结果 正常SMM组和低SMM组腹泻、恶心呕吐、胃痛/腹痛发生率比较,差异均无统计学意义(P>0.05).正常SMM组口腔黏膜炎、低蛋白血症、显性消化道出血、感染发生率低于低SMM组(P<0.05).正常SMM组患者口腔黏膜炎严重程度低于低SMM组(P<0.001).低SMM组患者中性粒细胞植活时间和血小板植活时间均长于正常SMM组(P<0.01).结论 移植前患者的低SMM发生率较高,低SMM与患者移植早期口腔黏膜炎发生、口腔黏膜炎严重度、低蛋白血症发生、显性消化道出血、感染及中性粒细胞和血小板植活时间延迟有关,患者移植前应尽早筛查,积极提升患者SMM,改善移植早期结果.
Background Allogeneic hematopoietic stem cell transplantation(allo-HSCT)is an effective treatment for hematopoietic malignancies.Malnutrition is a common complication and negatively affects prognosis.Muscle mass has been shown to reflect the nutritional status of patients earlier than blood biochemical parameters such as albumin.However,the influence of pre-transplantation skeletal muscle mass(SMM)on the complications associated with early transplantation remains unclear.Objective To investigate the effect of pre-transplant SMM on the early outcomes of allo-HSCT,provide a clinical basis for nutritional interventions and prognosis improvement.Methods A study was conducted with 77 leukemia patients who underwent allo-HSCT at the Medical Center of Hematology,Xinqiao Hospital of Army Medical University from January to October 2022.Bioelectrical impedance analysis was used to assess skeletal muscle mass.The patients were divided into the normal SMM group of 36 cases and low SMM group of 41 cases according to their SMM.Baseline data,including personal and clinical details,were collected.Early post-transplant complications(within 30 days post-transplant)such as oral mucositis,gastrointestinal symptoms,infection and hematopoietic reconstitution time between the two groups were compared using SPSS 23.0 software.Results There was no statistically significant difference in the incidence of diarrhea,nausea,vomiting,and abdominal pain/gastritis incidence between the normal and low SMM groups(P>0.05).The incidence of oral mucositis,hypoalbuminemia,overt gastrointestinal bleeding,and infection was lower in the normal SMM group than in the low SMM group(P<0.05).The severity of oral mucositis in patients in the normal SMM group was lower than that in the low SMM group(P<0.001).Neutrophil implantation time and platelet implantation time were longer in patients in the low SMM group than in the normal SMM group(P<0.01).Conclusion The pre-transplant patients had a high incidence of low SMM.The low SMM before transplantation correlates with the occurrence of oral mucositis,hypoalbuminemia,overt gastrointestinal bleeding,and infections,as well as extended neutrophil and platelet engraftment time in the early transplantation period,and patients should be screened as early as possible prior to transplantation to boost SMM and improve early post-transplant outcomes.

Hematologic diseasesHematopoietic stem cell transplantationSkeletal muscle massNutritional status

吴芳芳、杜珊珊、杜欣、许汝福、孙爱华、孔佩艳、高蕾、张曦

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400037 重庆市,陆军军医大学新桥医院血液病医学中心 创伤与化学中毒全国重点实验室 血液病与微环境重庆市重点实验室

400037 重庆市,陆军军医大学新桥医院营养科

400037 重庆市,陆军军医大学新桥医院药剂科

血液病 造血干细胞移植 骨骼肌质量 营养状况

重庆市科卫联合医学科研项目

2023ZDXM022

2024

中国全科医学
中国医院协会

中国全科医学

CSTPCD北大核心
影响因子:2.04
ISSN:1007-9572
年,卷(期):2024.27(14)
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