【摘要】 目的:严重的黏膜损伤是诱发造血干细胞移植后出现并发症的一常见原因,已有证据显示谷氨酰胺能降低接受化疗患儿黏膜炎的发生率。观察谷氨酰胺对异基因外周造血干细胞移植患者并发症及恢复的影响。方法:选择于2002-03/2006-11在河南省血液病研究所接受同胞异基因外周造血干细胞移植的48例血液系统肿瘤患者。所有患者及其家属对治疗和实验均知情同意,并经医院伦理委员会批准。所有患者移植前均处于完全缓解状态,营养中等或良好,心、肝、肾功能正常,将48例患者随机分为标准化全胃肠外营养液组(标准组,n=13)和加用谷氨酰胺的全胃肠外营养液组(谷氨酰胺组,n=35)。待患者中性粒细胞升至1.0×109L-1,且无任何感染指征,进行异基因外周造血干细胞移植。造血干细胞输注后第1天开始给予全胃肠外营养与胃肠外营养联合谷氨酰胺双肽,至中性粒细胞≥1.0×109L-1,且无消化道症状时停用。观察两组患者中性粒细胞恢复时间、出层流室时间以及关于感染、急性移植物抗宿主病等情况有无差异。结果:48例患者均进入结果分析。两组患者营养物质的摄入基本相同,谷氨酰胺组有6例发生黏膜炎,标准组有11例,差异显著(P<0.05);谷氨酰胺组有1例发生严重腹泻,标准组有5例,差异显著(P<0.05);谷氨酰胺组有3例发生临床感染,标准组有7例,差异显著(P<0.05);标准组中性粒细胞≥0.5×109L-1的持续时间短于谷氨酰胺组(P>0.05);谷氨酰胺组抗生素治疗时间及无菌病房居住时间较标准组短(P<0.05);两组急性移植物抗宿主病发生率差异无统计学意义(P>0.05)。结论:添加谷氨酰胺的全胃肠外营养可改善异基因造血干细胞移植患者的营养状态,减少感染及肠损害,减少急性移植物抗宿主病的发生,有利于异基因移植患者恢复。更多还原

【Abstract】 AIM: Severe mucositis is a common cause of morbidity in hematopoietic stem cell transplant recipients. Glutamine has been proved to reduce mucositis incidence in children receiving chemotherapy. This study was designed to investigate the effect of glutamine (Gln) on the complication and recovery of patients underwent allogeneic peripheral blood stem cell transplantation (allo-PBSCT). METHODS: Totally 48 patients receiving allo-PBSCT for hematological malignancies were selected from Henan Institute of Hematology between March 2002 and November 2006. Informed consent was obtained from all the patients and their family members before they enrolled,and the experiment was given approval by the hospital ethnics committee. Before transplantation,all the patients at complete remission were normalized in the heart,liver and kidney function,with mild or moderate nutrition. They were divided into two groups: the group of standard total parenteral nutrition (standard TPN group,n =13) and the group of standard TPN with Gln (Gln group,n =35). The allo-PBSCT was conducted for patients,in which neutrophil was over 1.0×109 L-1,without any infectious indication. TPN was initiated at day 1 after PBSCT to increase the neutrophil. Time to neutrophil recovery,time of leaving laminar flow ward,and other data related to hospital infection and acute graft-versus-host disease (aGVHD) were evaluated in all patients. RESULTS: All the 48 patients were involved in the result analysis. Nutrient intake was similar in both groups. Six patients in the Gln group developed mucositis while 11 cases in the standard group (P < 0.05). One patients in the Gln group developed severe diarrhea while 5 cases in the standard group (P < 0.05). Seven patients in the standard group developed clinical infection,however,just 3 cases in the Gln group did (P < 0.05). The time to exceed 0.5×109 L-1 neutrophils in the standard group was shorter than that in the Gln group (P > 0.05). The time of antibiotic requirements and free-germ ward stay were shorted in the standard group compared with the Gln group (P < 0.05). No significant difference was found in the aGVHD between the two groups (P > 0.05). CONCLUSION: Allogeneic hematopoietic stem cell transplantation patients will benefit from Gln-supplemented TPN for improving the nutritional status,diminishing the incidence of infection and the damage of intestine,and decreasing the incidence of aGVHD,which all help to recover.更多还原