营养控制状态评分对老年患者异基因造血干细胞移植治疗后并发口腔黏膜炎的预测价值^*

Controlling nutritional state score after allogeneic hematopoietic stem cell transplantation therapy for the elderly concurrent oral mucositis predictive value

摘要

目的 探讨营养控制状态评分 (CONUT) 对老年患者异基因造血干细胞移植治疗后并发口腔黏膜炎的预测价值。方法 选取2021年1月—2023年12月空军军医大学第一附属医院进行异基因造血干细胞移植治疗的80例老年患者为研究对象, 依据患者是否并发口腔黏膜炎分为口腔黏膜炎组 (24例) 和非口腔黏膜炎组 (56例)。采用ROC曲线分析CONUT评分对老年患者异基因造血干细胞移植治疗后并发口腔黏膜炎的预测价值; 采用多因素logistic回归分析老年患者异基因造血干细胞移植治疗后并发口腔黏膜炎的影响因素。结果 口腔黏膜炎组与非口腔黏膜炎组疾病类型、使用甲氨蝶呤、使用糖皮质激素、CONUT评分比较差异具有统计学意义 (P<0.05), 多因素logistic回归分析显示使用甲氨蝶呤、使用糖皮质激素、CONUT评分为口腔黏膜炎发生的独立危险因素 (P<0.05), 浆细胞疾病为独立保护因素 (P<0.05); CONUT评分预测老年患者异基因造血干细胞移植治疗后并发口腔黏膜炎的ROC曲线显示, AUC为0.841 (95%CI为0.741~0.941, P<0.001), 灵敏度为0.750, 特异度为0.839, 最大约登指数为0.589, 最佳临界值为6.94分, 提示其具有良好的预测价值。结论 CONUT评分可作为老年患者异基因造血干细胞移植治疗后口腔黏膜炎发生风险的预测工具, 具有重要的临床应用价值。

Abstract

Objective To investigate the predictive value of controlling nutritional status score (CONUT) for oral mucositis after allogeneic hematopoietic stem cell transplantation in the elderly. Methods Eighty elderly patients who underwent allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of Air Force Military Medical University from January 2021 to December 2023 were selected as the study subjects and divided into oral mucositis group (n = 24) and non-oral mucositis group (n = 56) according to whether the patients had oral mucositis. ROC curve was used to analyze the predictive value of CONUT score for oral mucositis after allogeneic hematopoietic stem cell transplantation in the elderly; multivariate logistic regression was used to analyze the factors of oral mucositis after allogeneic hematopoietic stem cell transplantation in the elderly. Results There were statistically significant differences in disease types, use of methotrexate, use of glucocorticoids, and CONUT scores between the oral mucositis group and the non-oral mucositis group (P<0.05). Multivariate logistic regression analysis showed that the use of methotrexate, glucocorticoids, and CONUT score as independent risk factor for the development of oral mucositis (P<0.05), and plasma cell disease was an independent protective factor (P<0.05). The ROC curve of the CONUT score for predicting oral mucositis after allogeneic hematopoietic stem cell transplantation in the elderly showed that the AUC was 0.841 (the 95%CI was 0.741 to 0.941, P<0.001), the sensitivity was 0.750, the specificity was 0.839, the maximum Youden index was 0.589, the optimal cut-off value was 6.94 points, indicates that it has good predictive value. Conclusion The CONUT score can be used as a predictive tool for the risk of oral mucositis in elderly patients after allogeneic hematopoietic stem cell transplantation, which has important clinical application value.

关键词

异基因造血干细胞移植 / 口腔黏膜炎 / 营养控制状态评分 / 影响因素

Key words

Allogeneic hematopoietic stem cell transplantation / Oral mucositis / Controlling nutritional status score / Influencing factors

参考文献

[1] Girisa S, Kumar A, Rana V, et al. From simple mouth cavities to complex oral mucosal disorders—curcuminoids as a promising therapeutic approach[J]. ACS Pharmacol Transl Sci, 2021, 4(2): 647-665.

[2] Villafuerte K, Martinez C, Dantas F T, et al. The impact of chemotherapeutic treatment on the oral microbiota of patients with cancer: a systematic review[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2018, 125(6): 552-566.

[3] Utsman R A, Epstein J B, Elad S. Budesonide for local therapy of complex oral mucosal immune—mediated inflammatory diseases: case reports[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 106(1): e11-17.

[4] Gezimu W, Demeke A, Duguma A. Noma—a neglected disease of malnutrition and poor oral hygiene:a mini—review[J]. SAGE Open Med, 2022, 10: 2050312122-1098110.

[5] Tsuda S, Nakayama M, Tanaka S, et al. The association of controlling nutritional status score and prognostic nutritional index with cardiovascular diseases: the fukuoka kidney disease registry study[J]. J Atheroscler Thromb, 2023, 30(4): 390-407.

[6] Arero G, Arero A G, Mohammed S H, et al. Prognostic potential of the controlling nutritional status (CONUT) score in predicting all—cause mortality and major adverse cardiovascular events in patients with coronary artery disease: a meta—analysis[J]. Front Nutr, 2022, 9: 850641.

[7] 顾艳荭, 桑燕, 朱健华. 癌症患者口腔黏膜炎评估的最佳实践[J]. 护士进修杂志, 2015, 30(11): 1010-1014.

[8] Gu Y H, Sang Y, Zhu J H. Best practices for the assessment of oral mucositis in cancer patients[J]. J Nurs Train, 2015, 30(11): 1010-1014.

[9] Kim D, Shim J, Kim Y G, et al. Malnutrition and risk of procedural complications in patients with atrial fibrillation undergoing catheter ablation[J]. Front Cardiovasc Med, 2021, 8: 736042.

[10] Costa—da—Silva A C, Aure M H, Dodge J, et al. Salivary ZG16B expression loss follows exocrine gland dysfunction related to oral chronic graft—versus—host disease[J]. iScience, 2022, 25(1): 103592.

[11] Zhou X Y, Pan Z W, Zhang J L, et al. [Research progress on prevention and local intervention of oral mucositis in patients with hematopoietic stem cell transplantation][J]. Chin J Stomatol, 2023, 58(5): 491-497.

[12] van Leeuwen S, Potting C, Huysmans M, et al. Salivary changes before and after hematopoietic stem cell transplantation: a systematic review[J]. Biol Blood Marrow Transplant, 2019, 25(6): 1055-1061.

[13] Enkobahry A, Sime T, Kene K, et al. Blood biomarkers as potential malnutrition screening alternatives among adult patients with cancer on treatment in oncology unit of jimma tertiary hospital: a cross—sectional analysis[J]. BMC Nutr, 2023, 9(1): 38.

[14] Li Z Z, Huang Q, Yang X L, et al. Cholesterol metabolic markers for differential evaluation of patients with hyperlipidemia and familial hypercholesterolemia[J]. Dis Markers, 2022, 2022: 2008556.

[15] He L, Zhou X, Huang N, et al. Functions of pregnane X receptor in self—detoxification[J]. Amino Acids, 2017, 49(12): 1999-2007.

[16] Knight R, Board—Davies E, Brown H, et al. Oral progenitor cell line—derived small extracellular vesicles as a treatment for preferential wound healing outcome[J]. Stem Cells Transl Med, 2022, 11(8): 861-875.

[17] Hesse J, Schmalfuss A, Kvaal S I. Photodynamic therapy of oral lichen planus[J]. Photochem Photobiol Sci, 2020, 19(10): 1271-1279.

[18] Vassilopoulos S, Shehadeh F, Kalligeros M, et al. Targeted therapies in CLL/SLL and the cumulative incidence of infection: a systematic review and meta—analysis[J]. Front Pharmacol, 2022, 13: 989830.

[19] Nakagaki M, Kennedy G A, Gavin N C, et al. The incidence of severe oral mucositis in patients undergoing different conditioning regimens in haematopoietic stem cell transplantation[J]. Support Care Cancer, 2022, 30(11): 9141-9149.

[20] Sadr—Azodi O, Mattsson F, Bexlius T S, et al. Association of oral glucocorticoid use with an increased risk of acute pancreatitis: a population—based nested case—control study[J]. JAMA Intern Med, 2013, 173(6): 444-449.

基金资助

^*国家自然科学基金(81960916)