急性白血病患儿治疗期人体组成成分的变化

目的 探讨不同治疗阶段的急性白血病患儿人体组成成分变化的特点,为其营养支持提供依据.方法 前瞻性观察2009年1月至2010年4月在上海儿童医学中心住院接受化疗的急性白血病患儿56例,同时选择同年龄同性别健康儿童56名作为正常对照组.使用节段多频生物电阻抗分析法对正常对照组儿童及在各个治疗期的第1个疗程结束时的白血病患儿进行人体组成成分测定.人体各组成成分的分布情况使用各成分占体重的百分比表示.结果 56例急性白血病患儿中,急性淋巴细胞性白血病41例,急性非淋巴细胞性白血病15例;处于诱导缓解期23例,巩固强化期15例,维持治疗期18例.56例白血病患儿与正常对照组儿童人体组成成分比较后发现,白血病患儿细胞内液(P=0.000)、细胞外液(P=0.005)、蛋白质(P=0.000)、无机盐(P=0.001)、骨骼肌(P=0.000)、体细胞群(P=0.000)和活动细胞群(P=0.000)占体重的百分比均明显低于正常对照组儿童,而体脂肪含量高于对照组(26.2±8.3)%比(20.3 ±3.8)%,P=0.000].诱导缓解期患儿的人体组成与正常对照组儿童相比,表现为体重下降(P=0.001),细胞内液(P=0.005)、蛋白质(P=0.004)、体细胞群(P=0.001)和活动细胞群(P=0.020)明显减少.进入巩固强化期的患儿,细胞内液(P=0.000)、细胞外液(P=0.000)、蛋白质(P=0.000)、无机盐(P=0.001)、体脂肪(P=0.000)、去脂体重(P=0.000)、骨骼肌(P=0.000)、体细胞群(P=0.000)和活动细胞群(P=0.000)占体重的百分比均明显低于正常对照组儿童.而维持治疗期的患儿与正常对照组儿童相比,除体重指数(P=0.127)和细胞外液占体重的百分比(P=0.097)差异无统计学意义外,其余各项指标差异仍具有统计学意义(P均<0.05).结论 急性白血病患儿经化疗后人体组成成分发生明显改变.应尽早监测白血病患儿营养状况变化,及时予以营养支持,以改善患儿预后.

Abstract：

Objective To investigate the changes of body composition in the children with acute leukemia during different treatment stages.Methods From January 2009 to April 2010,56 children with acute leukemia hospitalized in Shanghai Children's Medical Center for chemotherapy were enrolled.Meanwhile,56 healthy children with matched age and sex were enrolled as the control group.The body compositions of children in the control group and the children with acute leukemia at the end of the first course of each treatment stages ware detected by segmental multiple-frequency bioelectrical impedance analysis.The distribution of body compositions was recorded asthe percentage of each body composition to the body weighL Results Among 56 children with acute leukemia,41were with acute lymphoblastic leukemia and 15 with acute nonlymphoblasdc leukemia.Twenty-three cases were in remission-induction chemotherapy stage,15 in consolidation chemotherapy stage,and 18 in maintenance chemotherapy stage.Compared with children in the control group,children with acute leukemia showed a reduction in the percentage of intracellular fluid (P = 0.000), extracellular fluid (P - 0.005), protein (P = 0.000), mineral (P = 0.001), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000), while an increase in body fat mass (26.2 ± 8.3)% vs.(20.3±3.8)%, P=0.000].The body weight (P = 0.001), the percentage of intracellular fluid (P = 0.005), protein (P = 0.004), body cell mass (P = 0.001), and active cell mass ( P = 0.020 ) in the children during remission-induction chemotherapy stage were significantly lower than those of the healthy children.However, the parameters of the consolidation chemotherapy stage were significantly lower than those of the control group, including the percentage of intracellular fluid (P = 0.000), extracellular fluid (P =0.000), protein (P = 0.000), mineral (P =0.001), body fat mass (P =0.000), non-fat mass (P = 0.000), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000).Most body compositions in the maintenance chemotherapy stage were lower than those of the healthy children ( P < 0.05) except for body mass index (P = 0.127) and the percentage of extracellular fluid (P = 0.097).Conclusions Body compositions remarkably change in children with acute leukemia after chemotherapy.Therefore, the nutritional status of children with acute leukemia should be closely monitored, and proper nutritional support should be provided when necessary to improve the prognosis.

Changes of body composition in children with acute leukemia during different treatment stages

Objective To investigate the changes of body composition in the children with acute leukemia during different treatment stages.Methods From January 2009 to April 2010,56 children with acute leukemia hospitalized in Shanghai Children's Medical Center for chemotherapy were enrolled.Meanwhile,56 healthy children with matched age and sex were enrolled as the control group.The body compositions of children in the control group and the children with acute leukemia at the end of the first course of each treatment stages ware detected by segmental multiple-frequency bioelectrical impedance analysis.The distribution of body compositions was recorded asthe percentage of each body composition to the body weighL Results Among 56 children with acute leukemia,41were with acute lymphoblastic leukemia and 15 with acute nonlymphoblasdc leukemia.Twenty-three cases were in remission-induction chemotherapy stage,15 in consolidation chemotherapy stage,and 18 in maintenance chemotherapy stage.Compared with children in the control group,children with acute leukemia showed a reduction in the percentage of intracellular fluid (P = 0.000), extracellular fluid (P - 0.005), protein (P = 0.000), mineral (P = 0.001), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000), while an increase in body fat mass (26.2 ± 8.3)% vs.(20.3±3.8)%, P=0.000].The body weight (P = 0.001), the percentage of intracellular fluid (P = 0.005), protein (P = 0.004), body cell mass (P = 0.001), and active cell mass ( P = 0.020 ) in the children during remission-induction chemotherapy stage were significantly lower than those of the healthy children.However, the parameters of the consolidation chemotherapy stage were significantly lower than those of the control group, including the percentage of intracellular fluid (P = 0.000), extracellular fluid (P =0.000), protein (P = 0.000), mineral (P =0.001), body fat mass (P =0.000), non-fat mass (P = 0.000), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000).Most body compositions in the maintenance chemotherapy stage were lower than those of the healthy children ( P < 0.05) except for body mass index (P = 0.127) and the percentage of extracellular fluid (P = 0.097).Conclusions Body compositions remarkably change in children with acute leukemia after chemotherapy.Therefore, the nutritional status of children with acute leukemia should be closely monitored, and proper nutritional support should be provided when necessary to improve the prognosis.