造血干细胞移植患者肠外营养支持临床研究（新）..doc

造血干细胞移植患者肠外营养支持的临床研究 [摘要] 目的 分析与探讨肠外营养支持在造血干细胞移植中的运用。方法 回顾性分析106例接受造血干细胞移植患者的临床资料，分为肠外营养治疗组和非肠外营养支持组，比较两组患者在造血重建时间、口腔黏膜炎、肝功能异常、感染及移植物抗宿主病（GVHD）发生率的差异；进一步分析不同营养素的作用。结果 42例患者接受肠外营养支持，包含接受核黄素治疗有33例，谷氨酰胺24例，结构脂肪乳26例；肠外营养治疗组患者的口腔黏膜炎发生率显著低于非肠外营养支持组，分别为31.0% vs 51.6%（P=0.037），而两组的感染率、GVHD发生率、ALT中位水平以及造血重建中位时间均无显著差异；含有核黄素的肠外营养治疗组患者的口腔黏膜炎发生率显著低于非肠外营养支持组，分别为27.3% vs 51.6%（P=0.023），含有结构脂肪乳的肠外营养治疗组患者的ALT中位水平显著低于非肠外营养支持组，分别为38.7 vs 69.9 U/L（P=0.035）。结论 造血干细胞移植患者可能从合理的肠外营养支持中获益，核黄素对口腔黏膜炎的预防可能有益，结构脂肪乳在肝脏毒副作用方面可能更安全有效。 [关键词] 肠外营养；营养素；造血干细胞移植 [Abstract] Objective To investigate the importance of parenteral nutrition in hematopoietic stem cell transplantation and the roles of different nutrients. Methods Retrospective analysis of 106 patients with Hematopoietic stem cell transplantation. The patients were divided into parenteral nutrition group and the control group, compared in time of hematopoietic engraftment, rate of oral mucositis, incidence of liver dysfunction, rate of infections and incidence of graft versus host disease (GVHD). They were further broken down into riboflavin group, glutamine group and structolipid group, in which were analyzed the role of different nutrients. Results 42 patients received parenteral nutrition support, including 33 patients received treatment with riboflavin, 24 ones with glutamine, 26 ones with structolipid. The rate of oral mucositis of parenteral nutrition group and no parenteral nutrition group（NPN） was 13/42 and 33/64 (P = 0.037), the rate of infection 18/42 and 30/64 (P = 0.898), the incidence of GVHD 9/42 and 20/64 (P = 0.267), ALT level 49.5 vs 69.9 U / L (P = 0.168), the average time of hematopoietic engraftment 11.6 and 12.3 days (P = 0.187), respectively. The rate of oral mucositis in riboflavin group was significantly decreased versus the one of NPN group, which was 9/33 and 33/64 (P = 0.023), respectively. ALT levels of structolipid group was significantly lower than that of NPN group, which was 38.7 and 69.9 U/L (P = 0.035)