急性白血病患儿营养组分的临床分析

史立霞; 赵明忠; 王菲菲; 邢玉倩; 纪红燕; 赵平

doi:10.7499/j.issn.1008-8830.2408102

PDF(763 KB)

HTML

中国当代儿科杂志 ›› 2025, Vol. 27 ›› Issue (3) : 300-307. DOI: 10.7499/j.issn.1008-8830.2408102

论著·临床研究

急性白血病患儿营养组分的临床分析

史立霞¹, 赵明忠², 王菲菲³, 邢玉倩⁴, 纪红燕², 赵平^1,2

作者信息 +

Clinical analysis of nutritional components in children with acute leukemia

SHI Li-Xia, ZHAO Ming-Zhong, WANG Fei-Fei, XING Yu-Qian, JI Hong-Yan, ZHAO Ping

Author information +

文章历史 +

摘要

目的评估不同阶段急性白血病（acute leukemia, AL）患儿人体成分的变化及面临的营养风险。方法应用生物电阻抗技术联合人体测量方法检测人体成分，前瞻性研究2023年8月—2024年7月山东省立医院不同阶段AL患儿和健康儿童的人体成分和身体均衡情况。结果 AL患儿和健康儿童的非脂肪成分均随年龄呈线性增长。在低年龄组中，AL患儿与健康儿童人体成分无明显差异；在高年龄组中，AL化疗中患儿的人体成分显著低于健康儿童（P<0.05），肌肉质量在AL化疗结束后首先恢复。AL结束化疗患儿躯干脂肪升高的患儿比例显著低于健康儿童（P<0.05），而身体左右严重不均的比例显著高于后者（P<0.05）。AL患儿肌肉分布以四肢不足和全身不足为主，健康儿童则以上肢不足为主。结论 AL患儿在不同治疗阶段人体成分有不同，提示营养状况受疾病本身及治疗的影响，早期筛查可为合理营养干预提供依据。

Abstract

Objective To assess the changes in body composition and nutritional risks faced by children with different stages of acute leukemia (AL). Methods Bioelectrical impedance analysis combined with anthropometric measurements was used to detect body composition. This prospective study was conducted from August 2023 to July 2024 at Shandong Provincial Hospital, examining the body composition and physical balance of children with various stages of AL and healthy children. Results The non-fat components of children with AL and healthy children both showed a linear increase with age. In the younger age group, there were no significant differences in body composition between children with AL and healthy children. However, in the older age group, the body composition of children undergoing chemotherapy for AL was significantly lower than that of healthy children (P<0.05), and muscle mass recovered first after the completion of AL chemotherapy. The proportion of children with increased trunk fat in AL children who completed chemotherapy was significantly lower than that in healthy children (P<0.05), while the incidence rate of severe left-right imbalance in body composition was significantly higher (P<0.05). Muscle distribution in children with AL primarily showed insufficient limb and overall muscle mass, whereas healthy children mainly exhibited insufficient upper limb muscle mass. Conclusions The body composition of children with AL varies at different treatment stages, indicating that nutritional status is affected by both the disease itself and the treatment. Early screening can provide a basis for reasonable nutritional intervention.

导出引用

史立霞, 赵明忠, 王菲菲, 邢玉倩, 纪红燕, 赵平. 急性白血病患儿营养组分的临床分析[J]. 中国当代儿科杂志. 2025, 27(3): 300-307 https://doi.org/10.7499/j.issn.1008-8830.2408102

SHI Li-Xia, ZHAO Ming-Zhong, WANG Fei-Fei, XING Yu-Qian, JI Hong-Yan, ZHAO Ping. Clinical analysis of nutritional components in children with acute leukemia[J]. Chinese Journal of Contemporary Pediatrics. 2025, 27(3): 300-307 https://doi.org/10.7499/j.issn.1008-8830.2408102

参考文献

1 Triarico S, Rinninella E, Cintoni M, et al. Impact of malnutrition on survival and infections among pediatric patients with cancer: a retrospective study[J]. Eur Rev Med Pharmacol Sci, 2019, 23(3): 1165-1175. PMID: 30779086. DOI: 10.26355/eurrev_201901_17009.
2 Gallo N, Horvath K, Czuppon K, et al. Different nutritional screening tools and recommended screening algorithm for pediatric oncology patients[J]. Clin Nutr, 2021, 40(6): 3836-3841. PMID: 34130030. DOI: 10.1016/j.clnu.2021.05.013.
3 Bhutta ZA, Berkley JA, Bandsma RHJ, et al. Severe childhood malnutrition[J]. Nat Rev Dis Primers, 2017, 3: 17067. PMID: 28933421. PMCID: PMC7004825. DOI: 10.1038/nrdp.2017.67.
4 Leiva Badosa E, Badia Tahull M, Virgili Casas N, et al. Hospital malnutrition screening at admission: malnutrition increases mortality and length of stay[J]. Nutr Hosp, 2017, 34(4): 907-913. PMID: 29095016. DOI: 10.20960/nh.657.
5 Allard JP, Keller H, Jeejeebhoy KN, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: a prospective cohort study[J]. Clin Nutr, 2016, 35(1): 144-152. PMID: 25660316. DOI: 10.1016/j.clnu.2015.01.009.
6 Zhang H, Wang Y, Jiang ZM, et al. Impact of nutrition support on clinical outcome and cost-effectiveness analysis in patients at nutritional risk: a prospective cohort study with propensity score matching[J]. Nutrition, 2017, 37: 53-59. PMID: 28359363. DOI: 10.1016/j.nut.2016.12.004.
7 Cardenas D, Bermúdez C, Pérez A, et al. Nutritional risk is associated with an increase of in-hospital mortality and a reduction of being discharged home: results of the 2009-2015 nutritionDay survey[J]. Clin Nutr ESPEN, 2020, 38: 138-145. PMID: 32690148. DOI: 10.1016/j.clnesp.2020.05.014.
8 Zhang X, Tang T, Pang L, et al. Malnutrition and overall survival in older adults with cancer: a systematic review and meta-analysis[J]. J Geriatr Oncol, 2019, 10(6): 874-883. PMID: 30917937. DOI: 10.1016/j.jgo.2019.03.002.
9 Mejía-Aranguré JM, Fajardo-Gutiérrez A, Reyes-Ruíz NI, et al. Malnutrition in childhood lymphoblastic leukemia: a predictor of early mortality during the induction-to-remission phase of the treatment[J]. Arch Med Res, 1999, 30(2): 150-153. PMID: 10372451. DOI: 10.1016/s0188-0128(98)00026-8.
10 中国抗癌协会肿瘤营养专业委员会. 肿瘤恶液质临床诊断与治疗指南（2020版）[J]. 中国肿瘤临床, 2021, 48(8): 379-385. DOI: 10.3969/j.issn.1000-8179.2021.08.369.
11 冯一, 洪莉. 血液肿瘤患儿营养支持[J]. 中国实用儿科杂志, 2011, 26(3): 167-171.
12 Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: clinical nutrition in cancer[J]. Clin Nutr, 2021, 40(5): 2898-2913. PMID: 33946039. DOI: 10.1016/j.clnu.2021.02.005.
13 Rogers PC, Barr RD. The relevance of nutrition to pediatric oncology: a cancer control perspective[J]. Pediatr Blood Cancer, 2020,67Suppl 3:e28213. PMID: 32096351. DOI: 10.1002/pbc.28213.
14 Liz-Pimenta J, Tavares V, Neto BV, et al. Thrombosis and cachexia in cancer: two partners in crime?[J]. Crit Rev Oncol Hematol, 2023, 186: 103989. PMID: 37061076. DOI: 10.1016/j.critrevonc.2023.103989.
15 Iniesta RR, Paciarotti I, Brougham MF, et al. Effects of pediatric cancer and its treatment on nutritional status: a systematic review[J]. Nutr Rev, 2015, 73(5): 276-295. PMID: 26011902. DOI: 10.1093/nutrit/nuu062.
16 Serón-Arbeloa C, Labarta-Monzón L, Puzo-Foncillas J, et al. Malnutrition screening and assessment[J]. Nutrients, 2022, 14(12): 2392. PMID: 35745121. PMCID: PMC9228435. DOI: 10.3390/nu14122392.
17 Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition: an ESPEN consensus statement[J]. Clin Nutr, 2015, 34(3): 335-340. PMID: 25799486. DOI: 10.1016/j.clnu.2015.03.001.
18 Merchant RA, Seetharaman S, Au L, et al. Relationship of fat mass index and fat free mass index with body mass index and association with function, cognition and sarcopenia in pre-frail older adults[J]. Front Endocrinol (Lausanne), 2021, 12: 765415. PMID: 35002957. PMCID: PMC8741276. DOI: 10.3389/fendo.2021.765415.
19 Smith S, Madden AM. Body composition and functional assessment of nutritional status in adults: a narrative review of imaging, impedance, strength and functional techniques[J]. J Hum Nutr Diet, 2016, 29(6): 714-732. PMID: 27137882. DOI: 10.1111/jhn.12372.
20 Shepherd JA, Ng BK, Sommer MJ, et al. Body composition by DXA[J]. Bone, 2017, 104: 101-105. PMID: 28625918. PMCID: PMC5659281. DOI: 10.1016/j.bone.2017.06.010.
21 Ward LC. Bioelectrical impedance analysis for body composition assessment: reflections on accuracy, clinical utility, and standardisation[J]. Eur J Clin Nutr, 2019, 73(2): 194-199. PMID: 30297760. DOI: 10.1038/s41430-018-0335-3.
22 Joffe L, Schadler KL, Shen W, et al. Body composition in pediatric solid tumors: state of the science and future directions[J]. J Natl Cancer Inst Monogr, 2019, 2019(54): 144-148. PMID: 31532526. PMCID: PMC6750168. DOI: 10.1093/jncimonographs/lgz018.
23 Feng Y, Pan LY, Shen LY, et al. Changes in body composition in children with acute graft-versus-host disease within the first 100 days after hematopoietic stem cell transplantation[J]. Eur J Clin Nutr, 2018, 72(8): 1167-1175. PMID: 29269889. DOI: 10.1038/s41430-017-0057-y.
24 Seo YG, Kim JH, Kim Y, et al. Validation of body composition using bioelectrical impedance analysis in children according to the degree of obesity[J]. Scand J Med Sci Sports, 2018, 28(10): 2207-2215. PMID: 29938849. DOI: 10.1111/sms.13248.
25 Kyle UG, Earthman CP, Pichard C, et al. Body composition during growth in children: limitations and perspectives of bioelectrical impedance analysis[J]. Eur J Clin Nutr, 2015, 69(12): 1298-1305. PMID: 26039314. DOI: 10.1038/ejcn.2015.86.
26 Skipper A, Coltman A, Tomesko J, et al. Adult malnutrition (undernutrition) screening: an evidence analysis center systematic review[J]. J Acad Nutr Diet, 2020, 120(4): 669-708. PMID: 31866356. DOI: 10.1016/j.jand.2019.09.010.
27 Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization classification of haematolymphoid tumours: myeloid and histiocytic/dendritic neoplasms[J]. Leukemia, 2022, 36(7):1703?1719. PMID:35732831. DOI: 10.1038/s41375-022-01613-1.
28 中华医学会儿科学分会血液学组, 《中华儿科杂志》编辑委员会. 儿童急性淋巴细胞白血病诊疗建议（第四次修订）[J]. 中华儿科杂志, 2014, 52(9): 641-644. DOI: 10.3760/cma.j.issn.0578-1310.2014.09.001.
29 Ruiz J, Mathews C, Friehling E. What is childhood leukemia?[J]. JAMA, 2024, 331(9): 808. PMID: 38334982. DOI: 10.1001/jama.2023.24648.
30 Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients[J]. Clin Nutr, 2017, 36(1): 11-48. PMID: 27637832. DOI: 10.1016/j.clnu.2016.07.015.
31 孙超, 吴缤, 陈璐璐, 等. 儿童肿瘤疾病相关营养不良的评估进展[J]. 中国血液流变学杂志, 2020, 30(3): 406-410. DOI: 10.3969/j.issn.1009-881X.2020.03.036.
32 Sala A, Pencharz P, Barr RD. Children, cancer, and nutrition--a dynamic triangle in review[J]. Cancer, 2004, 100(4): 677-687. PMID: 14770421. DOI: 10.1002/cncr.11833.
33 Kazemi-Bajestani SM, Mazurak VC, Baracos V. Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes[J]. Semin Cell Dev Biol, 2016, 54: 2-10. PMID: 26343952. DOI: 10.1016/j.semcdb.2015.09.001.
34 Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index[J]. J Clin Oncol, 2013, 31(12): 1539-1547. PMID: 23530101. DOI: 10.1200/JCO.2012.45.2722.
35 中华医学会老年医学分会, 国家老年疾病临床医学研究中心（湘雅医院）.中国肌肉减少症诊疗指南（2024版）[J]. 中华医学杂志, 2025, 105(3): 181-203. DOI: 10.3760/cma.j.cn112137-20240724-01701.
36 Gilliam LA, St Clair DK. Chemotherapy-induced weakness and fatigue in skeletal muscle: the role of oxidative stress[J]. Antioxid Redox Signal, 2011, 15(9): 2543-2563. PMID: 21457105. PMCID: PMC3176345. DOI: 10.1089/ars.2011.3965.
37 Chen JL, Colgan TD, Walton KL, et al. The TGF-β signalling network in muscle development, adaptation and disease[J]. Adv Exp Med Biol, 2016, 900: 97-131. PMID: 27003398. DOI: 10.1007/978-3-319-27511-6_5.
38 Bernardoni F, Bernhardt N, Pooseh S, et al. Metabolic state and value-based decision-making in acute and recovered female patients with anorexia nervosa[J]. J Psychiatry Neurosci, 2020, 45(4): 253-261. PMID: 32129584. PMCID: PMC7828930. DOI: 10.1503/jpn.190031.
39 Delhanty PJ, Huisman M, Julien M, et al. The acylated (AG) to unacylated (UAG) ghrelin ratio in esterase inhibitor-treated blood is higher than previously described[J]. Clin Endocrinol (Oxf), 2015, 82(1): 142-146. PMID: 24810977. DOI: 10.1111/cen.12489.
40 Davis TR, Pierce MR, Novak SX, et al. Ghrelin octanoylation by ghrelin O-acyltransferase: protein acylation impacting metabolic and neuroendocrine signalling[J]. Open Biol, 2021, 11(7): 210080. PMID: 34315274. PMCID: PMC8316800. DOI: 10.1098/rsob.210080.
41 Bizzarri C, Rigamonti AE, Luce A, et al. Children with Prader-Willi syndrome exhibit more evident meal-induced responses in plasma ghrelin and peptide YY levels than obese and lean children[J]. Eur J Endocrinol, 2010, 162(3): 499-505. PMID: 20019130. DOI: 10.1530/EJE-09-1033.
42 Moschovi M, Trimis G, Vounatsou M, et al. Serial plasma concentrations of PYY and ghrelin during chemotherapy in children with acute lymphoblastic leukemia[J]. J Pediatr Hematol Oncol, 2008, 30(10): 733-737. PMID: 19011469. DOI: 10.1097/MPH.0b013e318179a1d8.
43 Bozzetti F, Arends J, Lundholm K, et al. ESPEN guidelines on parenteral nutrition: non-surgical oncology[J]. Clin Nutr, 2009, 28(4): 445-454. PMID: 19477052. DOI: 10.1016/j.clnu.2009.04.011.
44 Druml C, Ballmer PE, Druml W, et al. ESPEN guideline on ethical aspects of artificial nutrition and hydration[J]. Clin Nutr, 2016, 35(3): 545-556. PMID: 26923519. DOI: 10.1016/j.clnu.2016.02.006.