伊马替尼对慢性髓性白血病慢性期儿童身高的影响  

Effect of imatinib on the height of children with chronic myeloid leukemia in the chronic phase

作　　者：郑方圆[1] 张莉 张利强[3] 刘兵城 孟力 金洁[6] 刘会兰 孙自敏 林丽娥[8] 雷平冲[9] 竺晓凡 马洪霞[10] 陆泽生[11] 江华 赵艳红[13] 林海[14] 张雄[15] 杨赣萍[16] 朱焕玲[17] 陈苏宁[18] 游泳[19] 黎纬明[19] 白庆咸 赵谢兰[21] 李振宇 沈晓梅[23] 张乐萍[1] 江倩[1] Zheng Fangyuan;Zhang Yanli;Zhang Liqiang;Liu Bingcheng;Meng Li;Jin Jie;Liu Huilan;Sun Zimin;Lin Li’e;Lei Pingchong;Zhu Xiaofan;Ma Hongxia;Lu Zesheng;Jiang Hua;Zhao Yanhong;Lin Hai;Zhang Xiong;Yang Ganping;Zhu Huanling;Chen Suning;You Yong;Li Weiming;Bai Qingxian;Zhao Xielan;Li Zhenyu;Shen Xiaomei;Zhang Leping;Jiang Qian(Peking University People’s Hospital,Beijing 100044,China;Henan Cancer Hospital,Zhengzhou 450008,China;Beijing Children’s Hospital Affiliated to Capital Medical University,Beijing 100045,China;Institute of Hematology and Blood Diseases Hospital,CAMS&PUMC,Tianjin 300020,China;Tongji Hospital Affiliated to Huazhong University of Science and Technology,Wuhan 430030,China;The First Affiliated Hospital of Medical School of Zhejiang University,Hangzhou 310003,China;Affiliated Provincial Hospital of Anhui Medical University,Hefei 230001,China;Hainan General Hospital,Haikou 570311,China;Henan Provincial People’s Hospital,Zhengzhou 450003,China;The Third Hospital of Zhengzhou,Zhengzhou 450003,China;Guangdong General Hospital,Guangzhou 510080,China;Guangzhou Women and Children’s Medical Center,Guangzhou 510623,China;The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Jilin University First Hospital,Changchun 130021,China;Maoming People’s Hospital,Maoming 525000,China;The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;West China Hospital of Sichuan University,Chengdu 610041,China;The First Affiliated Hospital of Soochow University,Suzhou 215006,China;Union Hospital Affiliated to Huazhong University of Science and Technology,Wuhan 430022,China;Xijing Hospital of Air Force Medical University,Xi’an 710032,China;Xiangya Hospital of Central South University,Changsha 410008,China;Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;The First People’s Hospital of Yunnan Province,Kunming 650034,China)

机构地区：[1]北京大学人民医院,100044 [2]河南省肿瘤医院,郑州450008 [3]首都医科大学附属北京儿童医院,100045 [4]中国医学科学院血液病医院,天津300020 [5]华中科技大学附属同济医院,武汉430030 [6]浙江大学医学院附属第一医院,杭州310003 [7]安徽医科大学附属省立医院,合肥230036 [8]海南省人民医院,海口570311 [9]河南省人民医院,郑州450003 [10]郑州市第三人民医院,450003 [11]广东省人民医院,广州510080 [12]广州市妇女儿童医疗中心,510623 [13]哈尔滨医科大学附属第一医院,150001 [14]吉林大学第一医院,长春130021 [15]广东省茂名市人民医院,525000 [16]南昌大学附属第一医院,330006 [17]四川大学华西医院,成都610041 [18]苏州大学附属第一医院,215006 [19]华中科技大学附属协和医院,武汉430022 [20]空军军医大学西京医院,西安710032 [21]中南大学湘雅医院,长沙410008 [22]徐州医科大学附属医院,221002 [23]云南省第一人民医院,昆明650034

出　　处：《中华血液学杂志》2020年第7期545-551,共7页Chinese Journal of Hematology

基　　金：国家自然科学基金(81770161)。

摘　　要：目的:评估伊马替尼对慢性髓性白血病慢性期(CML-CP)儿童身高的影响。方法:2018年7月至2019年7月,在全国范围内对诊断时年龄<18周岁、接受伊马替尼治疗至少3个月的CML儿童或其家长发放问卷,调查受访者伊马替尼治疗前后身高的变化。主要评价指标为身高标准差积分值(HtSDS)以及标准差积分的差值(△HtSDS),并分析其相关影响因素。结果:共有238例受访者符合标准并被纳入研究,男性138例(58.0%),初诊时中位年龄11.0(1.4~17.9)岁,青春期前93例(39.0%),至填写答卷时,中位年龄15.0(2.0~34.0)岁,中位伊马替尼服药时间28(3~213)个月。受访者填写答卷时HtSDS(-0.063±1.361)较治疗前HtSDS(0.391±1.244)显著下降(P<0.001),71.0%的患儿出现身高增长减慢。青春期前服药者治疗后HtSDS下降显著(P<0.05),而青春期开始后服药者HtSDS变化不明显(P>0.05)。多因素分析显示,服药初始年龄较小(偏回归系数为0.122,B=0.572,t=10.733,P<0.001)和服药时间较长(偏回归系数为-0.006,B=-0.211,t=-4.062,P<0.001)是伊马替尼抑制身高增长的独立影响因素。结论:伊马替尼引起CML-CP儿童身高增长障碍,服药初始年龄越小、服药时间越长,伊马替尼对身高的影响越明显。Objective To evaluate the effect of imatinib on growth impairment in children with chronic myeloid leukemia(CML-CP)in the chronic phase.Methods From July 2018 to July 2019,questionnaires were distributed to CML children aged<18 years at the time of diagnosis who were receiving imatinib for at least 3 months or to their parents in China.The height-for-age standard deviation score(HtSDS)and the difference of standard deviation integral(△HtSDS)were used to explore the change in height with imatinib therapy.Results The data of 238 respondents were included;138(58.0%)respondents were men.The median age at the first diagnosis of CML was 11.0 years(range,1.4-17.9 years),and 93(39.0%)respondents were at the prepuberty stage.At the time of completing the questionnaires,the median age was 15.0 years(range,2.0-34.0 years).The median duration of imatinib therapy was 28 months(range,3-213 months).Among all the respondents,the mean HtSDS when completing the questionnaires(-0.063±1.361)was significantly lower than that at the time of starting imatinib treatment(0.391±1.244)(P<0.001).Total 71.0%respondents showed growth impairment that was more common in those starting imatinib therapy at prepubertal age than in those starting at pubertal age.Multivariate analysis showed that younger at the start of imatinib therapy(P<0.001)and longer duration of imatinib therapy(P<0.001)were significantly associated with severe growth impairment on imatinib therapy.Conclusions Imatinib induced growth impairment in children with CML-CP.Younger the age of initiation and longer the duration of imatinib therapy,more obvious the effect of imatinib on growth impairment.

关 键 词：儿童 伊马替尼 白血病 髓系 慢性 慢性期 身高 

分 类 号：R733.72[医药卫生—肿瘤]