儿童急性淋巴细胞白血病化疗合并培门冬酶相关胰腺炎临床分析  

Clinical analysis of PEG-asparaginase associated pancreatitis in children with acute lymphoblastic leukemia

作　　者：高琴丽[1] 陈彩[1] 乐少华[1] 李健[1] GAO Qinli;CHEN Cai;LE Shaohua;LI Jian.(Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Provincial Key Laboratory, Fujian Medical University Union Hospital, Fuzhou 350001, China)

机构地区：[1]福建医科大学附属协和医院小儿血液科,福建省血液病研究所,福建省血液病学重点实验室,福州350001

出　　处：《中国小儿血液与肿瘤杂志》2021年第5期285-288,293,共5页Journal of China Pediatric Blood and Cancer

基　　金：省卫生计生中青年骨干人才培养项目(2018-ZQN-26)。

摘　　要：目的探讨儿童急性淋巴细胞白血病(ALL)化疗合并培门冬酶相关胰腺炎的临床特点及诊治过程,提高其诊治水平及预后。方法回顾性分析2015年1月—2020年11月我院收治的39例ALL化疗合并培门冬酶相关胰腺炎患儿的临床资料。结果39例患者中32例以腹痛起病,1例以呕吐起病,1例以乏力起病,无症状者5例;10例患者合并呕吐,5例合并腹胀,7例合并休克。中重度患儿多合并低钠血症、感染及低蛋白血症,差别较轻度患儿有统计学意义(P<0.05)。轻中重型患儿在性别、年龄、是否合并代谢性酸中毒、肝功能异常、低钾血症及低纤维蛋白原血症上差异无统计学意义(P>0.05)。39例患者中18例再次使用门冬酰胺酶均未发生二次胰腺炎。其中20例轻型患者中6例继续使用培门冬酶化疗,6例改欧文菌门冬酰胺酶化疗;13例中度患者中5例改欧文菌门冬酰胺酶化疗,1例行欧文菌门冬酰胺酶化疗1疗程后改培门冬酶化疗;而6例重度患者均未再使用门冬酰胺酶化疗。结论培门冬酶相关胰腺炎临床表现多样,早期识别提早干预,特别对重症患者,可改善预后;轻中度患者在培门冬酶相关胰腺炎治愈后可再次尝试使用。Objective To analyze the clinical characteristics and treatment of PEG-asparaginase(PEG-ASP)associated pancreatitis in children with acute lymphoblastic leukemia(ALL),so as to improve the diagnosis,treatment and the prognosis of PEG-ASP associated pancreatitis.Methods Clinical data of 39 PEG-ASP associated pancreatitis children with acute lymphoblastic leukemia from Jan 2015 to Nov 2020 were analyzed retrospectively.Results Among 39 patients,32 patients had the initial symptom of abdominal pain,1 patient had the initial symptom of vomiting,1 patient had the initial symptom of fatigue,and 5 patients had no symptoms and signs.At the same time,10 patients had vomiting,5 patients had abdominal distension,and 7 patients had shock.Moderate/severe PEG-ASP associated pancreatitis had higher rate of hyponatremia,infection and hypoproteinemia than mild ones,and the differences were statistically significant.No differences in gender,age,metabolic acidosis,abnormal liver function,hypokalemia and hypofibrinogenemia were found between moderate/severe and mild PEG-ASP associated pancreatitis.Among 39 patients,there were 18 cases re-exposed to asparaginase,and none of them developed a second PEG-ASP associated pancreatitis.Among 20 mild PEG-ASP associated pancreatitis,6 patients were re-exposed to PEG-ASP,and another 6 patients were re-exposed to Erwinia-Asp.Among the 13 moderate PEG-ASP associated pancreatitis,5 patients were re-exposed to Erwinia-Asp,and one patient was re-exposed to a course of Erwinia-Asp then changed to PEG-ASP.None of the patients with severe PEG-ASP associated pancreatitis were re-exposed to asparaginase.Conclusions The clinical manifestations of PEG-ASP associated pancreatitis are various.Early recognition and management of PEG-ASP associated pancreatitis will significantly improve the prognosis,especially for the patients with severe PEG-ASP associated pancreatitis.Asparaginase re-exposure can be recommended for the patients with mild and moderate PEG-ASP associated pancreatitis.

关 键 词：急性淋巴细胞白血病 儿童 培门冬酶 门冬酰胺酶相关胰腺炎 

分 类 号：R73[医药卫生—肿瘤]