造血干细胞移植患儿急性期人体组分改变及其相关因素

摘要

Objective To describe changes in body composition of children during acute period after hematopoietic stem transplantation and to analyze their related factors. Methods From January to September 2012,40 patients undergoing hematopoietic stem cell transplantation in Shanghai Children's Medical Center were prospectively enrolled into the study. Height, weight and body composition were measured by direct segmental multi-frequency bioelectrical impedance analysis (DSM-BIA) were recorded before transplantation and at the 30th, 60th and 100th day after transplantation. Sex, age, transplantation method, graft source,total body irradiation,use of methylprednisolone, infection, the grade of mucositis and acute graft-versus-host disease (aGVHD) grade were also recorded. Results After hematopoietic stem cell transplantation, no significant change was observed in height Z-scores (F=0. 75,P = 0. 3883); body mass index(BMI) Z-values and fat-free mass for height (FFM-Ht) were significantly decreased but fat mass for height(FM-Ht) was also significantly increased(P<0. 05 or P<0. 01). After controlling children's age, the graft source was a significant factor affecting BMI Z and the total body irradiation was a significant factor affecting FM-Ht and infection was the a risk factor of FFM-Ht. Conclusion Children have high risks of emaciation and obesity during the acute period after hematopoietic stem cell transplantation. Irradiation may increase their fat mass, while infection may decreases fat-free mass. BMI may not be a good indicator to assess nutrition status of children undergoing transplantation.%目的 了解造血干细胞移植患儿急性期的人体组分变化情况并分析其相关因素.方法 前瞻性收集2012年1月至2012年9月在上海儿童医学中心进行造血干细胞移植的40例患儿的临床资料,在患儿进行造血干细胞移植前、移植后的第30、60和100天测量其身高、体质指数及使用直接节段多频生物电阻抗分析仪(DSM-BIA)测量人体组分指标,并记录患儿性别、年龄、移植方式、移植物来源、有无放疗、是否使用甲泼尼龙、有无感染、黏膜炎及急性移植物抗宿主病(aGVHD)分级.结果 造血干细胞移植后,患儿身高Z值无显著变化(F=0.75,P=0.3883),身体质量指数(body mass index,BMI)Z值和身高比去脂组织(FFM-Ht)显著下降,但身高比脂肪组织(FM-Ht)显著升高(P ＜0.05或P＜0.01).在控制患儿的年龄因素后,得到移植物来源为患儿BMI Z值的相关因素,全身放疗是FM-Ht的相关因素,而感染是FFM-Ht的危险因素.结论 造血干细胞移植患儿急性期存在消瘦和肥胖的风险,放疗会增加造血干细胞移植儿童的脂肪组织,而感染会减少患儿的去脂组织.BMI可能不是评估造血干细胞移植儿童营养状况的良好指标.