基于RUCAM量表的儿童急性淋巴细胞白血病化疗药物性肝损伤分析  

Analysis of chemotherapy drug-induced liver injury in children with acute lymphoblastic leukemia based on RUCAM scale

作　　者：李白[1] 刘健 毛舒婷 孟庆磊[2] 王叨[1] 赵彦婷[1] 苏淑芳[1] 魏林林[1] 刘玉峰[1] Li Bai;Liu Jian;Mao Shuting;Meng Qinglei;Wang Dao;Zhao Yanting;Su Shufang;Wei Linlin;Liu Yufeng(Department of Hematology and Oncology, Children′s Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第一附属医院儿童医院血液肿瘤科,450052 [2]河南省人民医院小儿外科,郑州450003

出　　处：《中华实用儿科临床杂志》2019年第3期200-204,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的分析急性淋巴细胞白血病(ALL)患儿化疗药物性肝损伤(DILI)的相关特征,提高临床医师对化疗DILI的认识,指导临床合理用药。方法回顾性分析2012年1月至2016年12月在郑州大学第一附属医院儿童医院血液肿瘤科初治的143例ALL病例,根据DILI诊断标准进行诊断,进一步采用Roussel uclaf因果关系评分法(RUCAM)进行量化评分,评分≥3分的病例存在化疗DILI。分别按性别、年龄、免疫分型、危险度和化疗阶段进行分组,比较DILI的发生率。按是否应用保肝药物分2组,比较DILI的预后情况。结果108例(75.52%)患儿发生DILI,66例(61.11%)出现肝损伤临床症状,无临床症状患儿42例(38.89%)。其中轻度损伤62例(57.41%),中度27例(25%),重度19例(17.59%)。临床分型肝细胞型86例(79.63%),胆汁淤积型8例(7.41%),混合型14例(12.96%)。发生DILI中男童80例(79.21%),女童28例(66.67%),男女2组患儿DILI发生率比较差异无统计学意义(χ^2=2.524,P=0.112)。<7岁75例发生DILI,发生率为77.32%(75/97例),≥7岁33例发生DILI,发生率为71.74%(33/46例),2组不同年龄患儿DILI发生率比较差异无统计学意义(χ^2=0.526,P=0.468)。T-ALL(8例、61.54%)与B-ALL(100例、76.92%)2组患儿DILI发生率比较差异无统计学意义(χ^2=0.795,P=0.372)。不同危险度患儿DILI发生率比较差异有统计学意义(P=0.002),中危组(60例、88.24%)与标危险组(21例、58.33%)比较差异有统计学意义(P<0.05),中危组与高危组(27例、69.23%)相比差异有统计学意义(P=0.015)。诱导缓解治疗阶段(42例、29.37%)DILI发生率与其他阶段相比差异均有统计学意义(均P<0.05)。RUCAM评分结果提示>8分者占19.45%;6~8分者占54.63%;3~5分者占25.92%。应用保肝药物治疗组有效率92.71%(89/96例),未用保肝药物组有效率66.67%(8/12例),2组DILI预后差异有统计学意义(χ^2=5.317,P=0.021)。结论儿童ALL化疗DILI无特征性临床表现,以轻度肝功能损伤为主。最常见的临床类型�Objective To analyze the characteristics of drug-induced liver injury (DILI) in children with acute lymphoblastic leukemia (ALL), so as to improve the physician′s understanding of chemotherapy DILI, and to guide clinical rational drug use. Methods One hundred and forty-three cases with ALL diagnosed in the Department of Hematology and Oncology in the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2016 were analyzed retrospectively.Based on DILI diagnostic criteria and the RUCAM scale, the cases with a score of ≥3 points were considered to have chemotherapy DILI.Grouped by gender, age, immunotyping, risk and stage of chemo-therapy, the incidence of DILI was compared.The situation after DILI prevention was compared between two groups which was grouped according to whether the application of hepatoprotective drugs. Results One hundred and eight cases (75.52%) had DILI, 66 cases (61.11%) showed clinical manifestations of liver injury, and 42 cases (38.89%) had no clinical symptoms.Among all the cases 57.41%(62 cases) were mild liver damage, 25%(27 cases) were moderate liver injury and 17.59%(19 cases) were severe liver damage.The clinical types which were hepatocellular accounting for 79.63%(86 cases), cholestatic 7.41%(8 cases) and mixed 12.96%(14 cases). Male were 80 cases (79.21%) and female 28 cases(66.67%), but the incidence of DILI between different gender group had no statistical difference (χ^2=2.524, P=0.112). Seventy-five cases(77.32%) were <7 years age and 33 cases(71.74%)≥7 years age, and the incidence of DILI between 2 groups was not statistically different (χ^2=0.526, P=0.468). There was no significant difference in T-ALL(8 cases, 61.54%) and B-ALL(100 cases, 76.92%)(χ^2=0.795, P=0.372). The incidence had significant difference in different risk (P=0.002). The incidence of DILI between the middle risk group(60 cases, 88.24%) and standard risk(21 cases, 58.33%) had statistical difference (P<0.05). The incidence of DILI between the middle risk group and severe ris

关 键 词：儿童 急性淋巴细胞白血病 RUCAM量表 化疗 药物性肝损伤 

分 类 号：R733.71[医药卫生—肿瘤]