摘要
骨髓移植前,清髓药物的不良反应会使患者的食欲、味觉、唾液腺功能、胃排空和肠道功能减退,并可引起严重的黏膜炎及移植物抗宿主病(GVHD),进而继发营养不良.GVHD可直接损伤皮肤、肝脏、黏膜、肺部、食管及肌肉骨骼等器官和组织,且长期应用免疫抑制剂防治GVHD,可导致内分泌和代谢系统疾病,包括胰岛素抵抗、脂质代谢异常、甲状腺功能减退或性腺功能减退等,从而导致营养不良.移植前已存在营养不良的患者接受异基因骨髓移植后营养不良可持续长达数年.通过营养治疗改善患者的营养状态,不仅可以减少移植患者急性GVHD的发生率,缩短植入时间,还可降低感染相关死亡率,延长生存期.
Abstract
Prior to bone marrow transplantation,adverse reactions to myeloablative drugs can lead to decreased appetite,taste,salivary gland function,gastric emptying,and intestinal function in patients,as well as severe mucosal inflammation and graft versus host disease(GVHD),leading to secondary malnutrition.GVHD can directly damage organs and tissues such as the skin,liver,mucosa,lungs,esophagus,and musculoskeletal system.Long term use of immunosuppressants to prevent and treat GVHD can lead to endocrine and metabolic system diseases,including insulin resistance,abnormal lipid metabolism,hypothyroidism or hypogonadism,resulting in malnutrition.Patients with pre-existing malnutrition before transplantation can sustain malnutrition for several years after receiving allogeneic bone marrow transplantation.Improving the nutritional status of patients through nutritional therapy can not only reduce the incidence of acute GVHD in transplant patients,shorten implantation time,but also reduce infection related mortality and prolong survival.
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