急性淋巴细胞白血病儿童营养状况与医院感染相关性研究  

Relationship between Nutritional Status and Nosocomial Infection in Children with Acute Lymphoblastic Leukemia

作　　者：林嘉乐 刘亢亢[1] 储金华[1] 黄玲玲[1] 谢志伟[1] 杨林海[1] 涂松济[1] 王宁玲[1] LIN Jia-Le;LIU Kang-Kang;CHU Jin-Hua;HUANG Ling-Ling;XIE Zhi-Wei;YANG Lin-Hai;TU Song-Ji;WANG Ning-Ling(Department of Paediatrics,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601,Anhui Province,China)

机构地区：[1]安徽医科大学第二附属医院儿科,安徽合肥230601

出　　处：《中国实验血液学杂志》2020年第3期767-774,共8页Journal of Experimental Hematology

摘　　要：目的:研究儿童急性淋巴细胞白血病患者治疗期间医院感染相关危险因素及感染特点,分析不同营养状况与医院感染及早期治疗反应之间的关系。方法:选取2016年6月至2019年6月纳入CCCG-ALL-2015方案治疗的133例儿童ALL患者的临床资料(化疗阶段、危险度、MRD等)、住院期间感染情况(感染病程、实验室指标、感染部位、转归等)及患儿的营养状况(性别、年龄、身高/身长、体重),采用χ^2检验、 Logistic回归分析进行统计学分析。结果:133例ALL患儿医院感染率为19.9%,其中感染相关死亡3例。性别、免疫表型、危险度对医院感染的发生均无明显影响(P>0.05),而中性粒细胞数、血红蛋白、血小板计数、化疗阶段、住院时长及营养状况对医院感染的发生均有影响(P<0.05)。Logistic多因素回归分析显示,化疗阶段、住院时长、中性粒细胞数、营养状况为独立危险因素,其中感染部位以呼吸道感染最多见,检测出的病原学中革兰阳性菌、革兰阴性菌及真菌各占44.1%、52.9%和2.9%。不同营养状况分组之间,d 19、46 MRD的阴性率差异均有统计学意义(P<0.05)。结论:中性粒细胞数、化疗阶段、住院时长、营养状况是医院感染的独立危险因素,其中营养状况与医院感染呈负相关,营养状况越差,发生医院感染的风险越高。营养不良及超重、肥胖均会影响ALL患儿的早期治疗反应,初诊时的营养水平可作为评估ALL患儿早期治疗反应的不良因素。Objective:To study the risk factors and infection characteristics of nosocomial infection in children with acute lymphoblastic leukemia(ALL)and analyze the relationship between different nutritional status and nosocomial infection,early treatment response.Method:The clinical data of 133 children with ALL treated with CCCG-ALL-2015 from June 2016 to June 2019(chemotherapy stage,risk level,MRD),infection during hospitalization(course of infection,laboratory indicators,sites of infection,outcome)and nutritional status(sex,age,height/length,weight)were enrolled.The Chi 2 test and Logistic regression analysis were used for statistical analysis.Results:The rate of nosocomial infection was 19.9%in 133 children with ALL,in which 3 were infection-related death.Sex,immunophenotype and risk showed no significantly affect on the occurrence of nosocomial infection(P>0.05),but neutrophil count,hemoglobin level,platelet count,chemotherapy stage,length of stay in hospital and nutritional status showed affect on the occurrence of nosocomial infection(P<0.05).Logistic multivariate regression analysis showed that chemotherapy stage,length of hospital stay,neutrophils and nutritional status were the independent risk factors,in which the respiratory tract infection was the most common.Gram-positive bacteria,Gram-negative bacteria and fungi accounted for 44.1%,52.9%and 2.9%respectively.The negative rate of MRD in day 19 and day 46 between different nutritional status groups showed statistically significant(P<0.05).Conclusion:Neutrophil count,chemotherapy stage,length of stay in hospital and nutritional status are independent risk factors for nosocomial infection.Among of them,nutritional status negatively correlated with nosocomial infection,and the poorer nutritional status,the higher risk of nosocomial infection.Malnutrition,overweight and obesity can affect the early treatment response of ALL children.The level of nutrition at first diagnosis can be used as a bad factor to evaluate the early treatment response of ALL children.

关 键 词：儿童急性淋巴细胞白血病 医院感染 营养状况 早期治疗反应 

分 类 号：R733.71[医药卫生—肿瘤]