Body Composition Analysis during Allogeneic Hematopoietic Stem Cell Transplantation in Overweight/Obese Patients with Hematologic Diseases

doi:10.12114/j.issn.1007-9572.2022.0392

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (30): 3755-3760.DOI: 10.12114/j.issn.1007-9572.2022.0392

Special Issue: 肥胖/减重最新文章合辑

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Body Composition Analysis during Allogeneic Hematopoietic Stem Cell Transplantation in Overweight/Obese Patients with Hematologic Diseases

1. Clinical Nutrition Department, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
2. Clinical Nutrition Department, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, China
3. Hematology Department, the First Affiliated Hospital of Soochow University, Suzhou 215000, China

Received:2022-04-10 Revised:2022-06-20 Published:2022-10-20 Online:2022-07-08
Contact: Jing YANG
About author:
ZHOU H, LING C J, XUE S L, et al. Body composition analysis during allogeneic hematopoietic stem cell transplantation in overweight/obese patients with hematologic diseases[J]. Chinese General Practice, 2022, 25 (30) : 3755-3760. ZHOU Hui and LING Chenjie are co-first authors

超重/肥胖血液病患者异基因造血干细胞移植期间身体成分研究

1．215000　江苏省苏州市，苏州大学附属第一医院临床营养科
2．215000　江苏省苏州市，苏州大学附属独墅湖医院临床营养科
3．215000　江苏省苏州市，苏州大学附属第一医院血液科

通讯作者: 杨晶
作者简介:
周慧与凌晨洁为共同第一作者周慧，凌晨洁，薛胜利，等.超重/肥胖血液病患者异基因造血干细胞移植期间身体成分研究[J].中国全科医学，2022，25（30）：3755-3760.[www.chinagp.net] 作者贡献：周慧、凌晨洁进行数据整理与论文撰写；薛胜利、杨晶负责设计方案、提供资金及论文审核；周慧负责最终版本的修订，对论文整体负责。
基金资助:
国家自然科学基金资助项目(81803216，81970138); 苏州市卫生青年骨干人才"全国导师制"项目(Qngg2021004); 第五批姑苏卫生人才培养项目(GSWS2019007)

Abstract

Abstract:

Background

With the rise of overweight/obese people around the world, the prevalence of allogeneic hematopoietic stem cell transplantation (HSCT) for treating hematologic diseases in this population is also increasing. Obesity has been reported to be associated with poor prognosis after transplantation. More research should be conducted to improve the poor outcome in these patients.

Objective

To analyze the characteristics of body composition changes in overweight/obese patients with hematologic diseases during allogeneic HSCT, providing evidence and ideas for the delivery of nutritional intervention in the transplantation for these patients.

Methods

Two hundred and twelve hematologic disease patients with allogeneic HSCT were selected from the First Affiliated Hospital of Soochow University from November 2018 to March 2021. Baseline data, including personal demographics and clinical information, were collected. SPSS 26.0 software was used to compare the changes in body composition and abnormal glucolipid metabolism parameters between patients with normal BMI (normal group, n=137) and those with overweight/obesity (overweight/obese group, n=75) on the day before and after pretreatment, as well as 14 days after transplantation.

Results

The normal and overweight/obese groups had no significant differences in sex ratio, mean age, diagnosis, preconditioning regimen and HLA typing (P>0.05) . Fourteen days after the allogeneic HSCT, overweight/obese patients had obviously decreased body weight (t=14.271, P<0.001) , fat-free body weight (t=12.344, P<0.001) , skeletal muscle mass (t=14.119, P<0.001) , BMI (t=14.119, P<0.001) and fat-free mass index (FFMI) (t=12.344, P<0.001) , insignificantly changed body fat (P>0.05) , and significantly increased body fat percentage and visceral fat area (t=-3.258, -2.478, P<0.05) . Compared with normal BMI group, overweight/obese group had a more significant decrease in muscle-related indicators such as fat-free body weight, skeletal muscle mass and FFMI (t=3.525, 3.728, 3.545, P<0.05) at 14 days after the allogeneic HSCT. Moreover, the incidence of abnormal fasting glucose and hypercholesterolemia in overweight/obesity group was significantly higher (χ²=7.250, 4.665, P<0.05) .

Conclusion

We found that overweight/obese patients had a more significant decrease in skeletal muscle mass, a tendency of visceral fat accumulation, and a higher risk of abnormal glycolipid metabolism after the allogeneic HSCT. In view of this, more attention should be given to body weight and body composition in the overweight/obese patients, and corresponding nutrition intervention should be provided to them during the peri-transplant period.

Key words: Obesity, Hematopoietic stem cell transplantation, Hematologic diseases, Body composition, Skeletal muscle mass, Body mass index, Fat free mass index

摘要：

背景

随着全球超重/肥胖人群的不断增多，接受异基因造血干细胞移植的血液病患者中超重/肥胖者也越来越多。已有研究报道肥胖与移植后的预后不良有关，为改善此类患者的不良预后应该进行更多的研究。

目的

本研究拟探索异基因造血干细胞移植过程中超重/肥胖血液病患者身体成分变化的特点，为超重/肥胖患者移植过程中实施营养干预提供证据和思路。

方法

选取2018年11月至2021年3月于苏州大学附属第一医院接受异基因造血干细胞移植的212例血液病患者为研究对象，根据体质指数（BMI）分为BMI正常组（137例）和超重/肥胖组（75例）。收集患者基线资料，包括个人信息和临床资料等，采用SPSS 26.0软件比较两组患者入仓时、预处理后和出仓时的身体成分变化情况及糖脂代谢相关指标异常发生率情况。

结果

两组患者性别、年龄、疾病类型、预处理方案及人类白细胞抗原（HLA）配型比较，差异均无统计学意义（P>0.05）。超重/肥胖组患者接受异基因造血干细胞移植后，体质量（t=14.271，P<0.001）、去脂体质量（t=12.344，P<0.001）、骨骼肌质量（t=14.119，P<0.001）、BMI（t=14.610，P<0.001）、去脂体质指数（FFMI）（t=12.344，P<0.001）均较移植前下降；超重/肥胖组患者体脂肪在移植前后无明显变化（P>0.05），但体脂百分比、内脏脂肪面积移植后却明显升高（t=-3.258、-2.478，P<0.05）。与BMI正常组相比，超重/肥胖组患者与肌肉相关的指标如去脂体质量、骨骼肌质量和FFMI下降明显（t=3.525、3.728、3.545，P<0.05）。出仓时超重/肥胖组患者的空腹血糖异常和高胆固醇血症的发生率均高于BMI正常组（χ²=7.250、4.665，P<0.05）。

结论

本研究发现超重/肥胖血液病患者异基因造血干细胞移植后出现更加明显的骨骼肌下降，且存在内脏脂肪堆积的趋势，移植后糖脂代谢异常的比例更高。医护人员应该关注超重/肥胖患者整个移植期间的体质量及身体成分变化，并实施相应的营养干预。

关键词: 肥胖症, 造血干细胞移植, 血液病, 身体成分, 骨骼肌质量, 体质指数, 去脂体质量指数

Hui ZHOU,Chenjie LING,Shengli XUE, et al. Body Composition Analysis during Allogeneic Hematopoietic Stem Cell Transplantation in Overweight/Obese Patients with Hematologic Diseases[J]. Chinese General Practice, 2022, 25(30): 3755-3760. DOI: 10.12114/j.issn.1007-9572.2022.0392.
周慧,凌晨洁,薛胜利等. 超重/肥胖血液病患者异基因造血干细胞移植期间身体成分研究[J]. 中国全科医学, 2022, 25(30): 3755-3760. DOI: 10.12114/j.issn.1007-9572.2022.0392.

Figures/Tables 4

References 30

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组别	例数	性别（男/女）	年龄〔M（P₂₅，P₇₅），岁〕	疾病类型（急性髓系白血病/急性淋巴细胞白血病/骨髓增生异常综合征/其他）	预处理方案（清髓性方案/减低剂量方案）	HLA配型（全相合/不全相合）
BMI正常组	137	93/44	38.0（27.0，48.0）	52/38/23/24	123/14	54/83
超重/肥胖组	75	44/31	39.0（26.0，48.0）	34/17/15/9	71/4	33/42
χ²（Z）值		1.801	-0.030^a	2.358	1.489	0.421
P值		0.180	0.976	0.502	0.222	0.516

组别	例数	性别（男/女）	年龄〔M（P₂₅，P₇₅），岁〕	疾病类型（急性髓系白血病/急性淋巴细胞白血病/骨髓增生异常综合征/其他）	预处理方案（清髓性方案/减低剂量方案）	HLA配型（全相合/不全相合）
BMI正常组	137	93/44	38.0（27.0，48.0）	52/38/23/24	123/14	54/83
超重/肥胖组	75	44/31	39.0（26.0，48.0）	34/17/15/9	71/4	33/42
χ²（Z）值		1.801	-0.030^a	2.358	1.489	0.421
P值		0.180	0.976	0.502	0.222	0.516

时间	体质量（kg）	去脂体质量（kg）	骨骼肌质量（kg）	BMI（kg/m²）
入仓时	75.22±9.60	53.63±8.53	29.68±5.06	26.20±1.81
预处理后	73.69±9.28^a	52.50±7.97^a	28.69±4.74^a	25.67±1.78^a
出仓时	70.77±9.20^ab	49.66±7.93^ab	26.92±4.69^ab	24.67±1.95^ab
F值	141.724	88.322	118.196	141.384
P值	<0.001	<0.001	<0.001	<0.001
时间	FFMI（kg/m²）	体脂肪（kg）	体脂百分比（%）	内脏脂肪面积（cm²）
入仓时	18.64±1.88	21.60±6.37	28.68±7.52	92.48±39.78
预处理后	18.27±1.75^a	21.18±6.39	28.65±7.38	96.09±41.87
出仓时	17.27±1.80^ab	21.13±5.85	29.83±7.23^ab	98.90±39.98^a
F值	86.639	1.351	7.173	3.391
P值	<0.001	0.262	0.001	0.036

时间	体质量（kg）	去脂体质量（kg）	骨骼肌质量（kg）	BMI（kg/m²）
入仓时	75.22±9.60	53.63±8.53	29.68±5.06	26.20±1.81
预处理后	73.69±9.28^a	52.50±7.97^a	28.69±4.74^a	25.67±1.78^a
出仓时	70.77±9.20^ab	49.66±7.93^ab	26.92±4.69^ab	24.67±1.95^ab
F值	141.724	88.322	118.196	141.384
P值	<0.001	<0.001	<0.001	<0.001
时间	FFMI（kg/m²）	体脂肪（kg）	体脂百分比（%）	内脏脂肪面积（cm²）
入仓时	18.64±1.88	21.60±6.37	28.68±7.52	92.48±39.78
预处理后	18.27±1.75^a	21.18±6.39	28.65±7.38	96.09±41.87
出仓时	17.27±1.80^ab	21.13±5.85	29.83±7.23^ab	98.90±39.98^a
F值	86.639	1.351	7.173	3.391
P值	<0.001	0.262	0.001	0.036

组别	例数	体质量	去脂体质量	骨骼肌质量	BMI	FFMI	体脂肪	体脂百分比	内脏脂肪面积
BMI正常组	137	-4.82±3.78^a	-4.57±5.62^a	-6.04±6.18^a	-4.81±3.80^a	-4.54±5.59^a	-2.33±22.2^a	2.53±22.93	24.25±122.17
超重/肥胖组	75	-5.89±3.37^a	-7.29±4.91^a	-9.21±5.42^a	-5.85±3.40^a	-7.27±4.91^a	0.13±18.19	6.39±19.57^a	10.85±25.93^a
t值		2.062	3.525	3.728	1.984	3.545	-0.868	-1.291	0.937
P值		0.040	0.001	<0.001	0.049	<0.001	0.386	0.198	0.350

Body Composition Analysis during Allogeneic Hematopoietic Stem Cell Transplantation in Overweight/Obese Patients with Hematologic Diseases

超重/肥胖血液病患者异基因造血干细胞移植期间身体成分研究

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组别	例数	空腹血糖异常			高胆固醇血症			高低密度脂蛋白血症			高三酰甘油血症
组别	例数	入仓时	预处理后	出仓时	入仓时	预处理后	出仓时	入仓时	预处理后	出仓时	入仓时	预处理后	出仓时
BMI正常组	137	21（15.3）	72（53.6）	22（16.1）	23（16.8）	31（22.6）	32（23.4）	17（12.4）	41（29.9）	31（22.6）	59（43.1）	98（71.5）	104（75.9）
超重/肥胖组	75	18（24.0）	46（61.3）	24（32.0）	20（26.7）	20（26.8）	28（37.3）	14（18.7）	29（38.7）	26（34.7）	34（45.3）	60（80.0）	62（82.7）
χ²值		2.428	1.513	7.250	2.925	0.433	4.665	1.520	1.674	3.573	0.177	1.830	1.301
P值		0.119	0.219	0.007	0.087	0.511	0.031	0.218	0.196	0.059	0.674	0.176	0.254

组别	例数	空腹血糖异常			高胆固醇血症			高低密度脂蛋白血症			高三酰甘油血症
组别	例数	入仓时	预处理后	出仓时	入仓时	预处理后	出仓时	入仓时	预处理后	出仓时	入仓时	预处理后	出仓时
BMI正常组	137	21（15.3）	72（53.6）	22（16.1）	23（16.8）	31（22.6）	32（23.4）	17（12.4）	41（29.9）	31（22.6）	59（43.1）	98（71.5）	104（75.9）
超重/肥胖组	75	18（24.0）	46（61.3）	24（32.0）	20（26.7）	20（26.8）	28（37.3）	14（18.7）	29（38.7）	26（34.7）	34（45.3）	60（80.0）	62（82.7）
χ²值		2.428	1.513	7.250	2.925	0.433	4.665	1.520	1.674	3.573	0.177	1.830	1.301
P值		0.119	0.219	0.007	0.087	0.511	0.031	0.218	0.196	0.059	0.674	0.176	0.254