摘要
目的探讨短肽型肠内营养制剂对急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患儿化疗期间营养状态、免疫功能和不良反应的影响。方法选取2021年1月至2022年4月于济宁医学院附属医院接受化疗的ALL患儿106例,按照组间基线资料匹配的原则,采用随机数字表法分为对照组和观察组,各53例。两组患儿均接受2020年中国儿童肿瘤专业委员会ALL多中心协作组方案化疗,对照组患儿给予常规饮食,观察组患儿给予常规饮食+短肽型肠内营养制剂小百肽。比较两组患儿PVDL[泼尼松(高危T系加地塞米松)+长春新碱+柔红霉素+培门冬酶]诱导缓解期、CAT(环磷酰胺+阿糖胞苷+巯嘌呤)诱导缓解期、CAT+(环磷酰胺+阿糖胞苷+巯嘌呤+长春新碱+培门冬酶)早期强化期、大剂量甲氨蝶呤(high dose methotrexate,HDMTX)巩固治疗期、再诱导治疗期、间期治疗期、维持治疗期7个化疗阶段营养不良、低蛋白血症、低白蛋白血症发生率,血清免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白M(immunoglobulin,IgM)和免疫球蛋白A(immunoglobulin A,IgA)水平异常发生率,肝损害和感染等不良反应发生率。正态或近似正态分布的计量资料以x±s表示,组间比较采用两独立样本t检验;计数资料以例(%)表示,组间比较采用χ^(2)检验。结果CAT诱导缓解期,观察组ALL患儿营养不良发生率低于对照组[20.8%(11/53)比39.6%(21/53),χ^(2)=4.48、P=0.034]。HDMTX巩固治疗期、再诱导治疗期、间期治疗期以及维持治疗期,观察组患儿低蛋白血症发生率均低于对照组[47.2%(25/53)比69.8%(37/53),χ^(2)=5.60、P=0.018;45.3%(24/53)比67.9%(36/53),χ^(2)=5.53、P=0.019;41.5%(24/53)比64.2%(34/53),χ^(2)=5.45、P=0.020;28.3%(15/53)比54.7%(29/53),χ^(2)=7.62、P=0.006]。CAT+早期强化期、HDMTX巩固治疗期、再诱导治疗期、间期治疗期以及维持治疗期,观察组患儿的低白蛋白血症发生率均低于对照组[5.7%(3/53)比22.6%(12/53),χ^(2)=6.29、P=0.012;9.4%(5/53)比26.4%(14/53),χ^(2)=5.19、P=0.023;9.4%(5/53)比28.3%(15/53),χ^(2)=6.16、P=0.013;7.6%(4/53)比24.5%(13/53),χ^(2)=5.68、P=0.017;3.8%(2/53)比18.9%(10/53),χ^(2)=6.01、P=0.014]。再诱导治疗期、间期治疗期以及维持治疗期,观察组患儿的IgG异常发生率均低于对照组[20.8%(11/53)比39.6%(21/53),χ^(2)=4.48、P=0.034;7.6%(4/53)比22.6%(12/53),χ^(2)=4.71、P=0.030;11.3%(6/53)比26.4%(14/53),χ^(2)=3.94、P=0.047]。CAT诱导缓解期和CAT+早期强化期,观察组患儿的IgM异常发生率均低于对照组[45.3%(24/53)比66.0%(35/53),χ^(2)=4.63、P=0.032;58.5%(31/53)比77.4%(41/53),χ^(2)=4.33、P=0.037]。再诱导治疗期、间期治疗期,观察组患儿的IgA异常发生率均低于对照组[22.6%(12/53)比45.3%(24/53),χ^(2)=6.06、P=0.014;9.4%(5/53)比24.5%(13/53),χ^(2)=4.28、P=0.038]。CAT诱导缓解期、CAT+早期强化期以及维持治疗期,观察组患儿的肝损害发生率均低于对照组[22.6%(12/53)比43.4%(23/53),χ^(2)=5.16、P=0.023;26.4%(14/53)比50.9%(27/53),χ^(2)=6.72、P=0.010;11.3%(6/53)比26.4%(14/53),χ^(2)=3.94、P=0.047]。CAT+早期强化期和HDMTX巩固治疗期,观察组患儿的感染发生率均低于对照组[35.9%(19/53)比56.6%(30/53),χ^(2)=4.59、P=0.032;24.5%(13/53)比43.4%(23/53),χ^(2)=4.21、P=0.040]。结论短肽型肠内营养制剂在儿童ALL的治疗中具有显著的优势,其通过改善患儿营养状况、调节免疫功能和减少化疗不良反应,为患儿的治疗和康复提供有力的支持。
Objective To investigate the effects of short-peptide-based enteral nutrition on nutritional status,immune function,and chemotherapy-related adverse reactions in children with acute lymphoblastic leukemia(ALL).Methods A total of 106 children with ALL receiving chemotherapy at the Affiliated Hospital of Jining Medical University between January 2021 and April 2022 were enrolled.According to the principle of between-group baseline data matching,the patients were divided into observation group and control group by random number table method,with 53 cases in each group.All patients received chemotherapy according to the CCCG-ALL-2020 protocol established by the Multi-center Cooperative Group of the Chinese Society of Pediatric Oncology(2020).The control group received a regular diet,while the observation group received a regular diet supplemented with short-peptide-based enteral nutrition.The incidence rates of malnutrition,hypoproteinemia,hypoalbuminemia,abnormal immunoglobulin levels(IgG,IgM,IgA),and adverse reactions(liver injury,infection)were compared between both groups before chemotherapy and at the end of each of the following seven chemotherapy phases:Induction remission therapy(PVDL),Induction remission therapy(CAT),Early intensification therapy(CAT+),Consolidation therapy(HDMTX),Interim maintenance therapy,Reinduction therapy,and prior to the end of Maintenance therapy.Normally or approximately normally distributed measurement data were expressed as x±s and compared by independent samples t-test.Counting data were expressed as n(%)and compared by χ^(2) test.Results During the CAT phase,the incidence of malnutrition was significantly lower in the observation group than in the control group[20.8%(11/53)vs.39.6%(21/53),χ^(2)=4.48,P=0.034].The incidence of hypoproteinemia was significantly lower in the observation group during HDMTX,Reinduction,Interim maintenance,and prior to the end of Maintenance therapy[47.2%(25/53)vs.69.8%(37/53),χ^(2)=5.60,P=0.018;45.3%(24/53)vs.67.9%(36/53),χ^(2)=5.53,P=0.019;41.5%(24/53)vs.64.2%(34/53),χ^(2)=5.45,P=0.020;28.3%(15/53)vs.54.7%(29/53),χ^(2)=7.62,P=0.006,respectively].The incidence of hypoalbuminemia was significantly lower in the observation group during CAT+,HDMTX,Reinduction,Interim maintenance,and prior to the end of Maintenance therapy[5.7%(3/53)vs.22.6%(12/53),χ^(2)=6.29,P=0.012;9.4%(5/53)vs.26.4%(14/53),χ^(2)=5.19,P=0.023;9.4%(5/53)vs.28.3%(15/53),χ^(2)=6.16,P=0.013;7.6%(4/53)vs.24.5%(13/53),χ^(2)=5.68,P=0.017;3.8%(2/53)vs.18.9%(10/53),χ^(2)=6.01,P=0.014,respectively].For IgG,incidence was significantly lower in the observation group during Interim maintenance,Reinduction,and prior to the end of Maintenance therapy[7.6%(4/53)vs.22.6%(12/53),χ^(2)=4.71,P=0.030;20.8%(11/53)vs.39.6%(21/53),χ^(2)=4.48,P=0.034;11.3%(6/53)vs.26.4%(14/53),χ^(2)=3.94,P=0.047,respectively].For IgM,incidence was significantly lower in the observation group during the CAT and CAT+phases[45.3%(24/53)vs.66.0%(35/53),χ^(2)=4.63,P=0.032;58.5%(31/53)vs.77.4%(41/53),χ^(2)=4.33,P=0.037,respectively].For IgA,incidence was significantly lower in the observation group during Reinduction therapy and Interim maintenance[22.6%(12/53)vs.45.3%(24/53),χ^(2)=6.06,P=0.014;9.4%(5/53)vs.24.5%(13/53),χ^(2)=4.28,P=0.038,respectively].For liver injury,incidence was significantly lower in the observation group during the CAT,CAT+,and prior to the end of Maintenance phases[22.6%(12/53)vs.43.4%(23/53),χ^(2)=5.16,P=0.023;26.4%(14/53)vs.50.9%(27/53),χ^(2)=6.72,P=0.010,11.3%(6/53)vs.26.4%(14/53),χ^(2)=3.94、P=0.047,respectively].For infection,incidence was significantly lower in the observation group during the CAT+and HDMTX phases[35.9%(19/53)vs.56.6%(30/53),χ^(2)=4.59,P=0.032;24.5%(13/53)vs.43.4%(23/53),χ^(2)=4.21,P=0.040,respectively].Conclusions Short-peptide-based enteral nutrition demonstrates significant advantages in the treatment of pediatric ALL.It provides substantial support for patient treatment and recovery by improving nutritional status,modulating immune function,and reducing chemotherapy-related adverse reactions.
作者
黄宗宣
李涛
盛芬
王缦
胡田田
张滕
张文莉
陶艳玲
Huang Zongxuan;Li Tao;Sheng Fen;Wang Man;Hu Tiantian;Zhang Teng;Zhang Wenli;Tao Yanling(Department of Pediatrics,Affiliated Hospital of Jining Medical University,Jining 272001,China;Respiratory Intensive Care Unit,Jining No.1 People's Hospital,Jining 272002,China)
出处
《中国综合临床》
2025年第4期273-281,共9页
Clinical Medicine of China
基金
山东省自然科学基金(ZR2023MH208)
济宁医学院附属医院主诊医师团队专项临床研究计划项目(ZZTD-MS-2023-07)。
关键词
白血病
肠内营养
免疫功能
不良反应
Leukemia
Enteral nutrition
Immune function
Adverse reactions
