益生菌对接受大剂量甲氨蝶呤的ALL患儿影响及经济学分析  

Effect of probiotics on children patients with ALL receiving high-dose methotrexate and its economic analysis

作　　者：孟艳 翟小颖[2] 东蕾[1] 付海燕[3] 张古英[1] MENG Yan;ZHAI Xiaoying;DONG Lei;FU Haiyan;ZHANG Guying(Department of Pharmacy,Hebei Children′s Hospital,Hebei Shijiazhuang 050031,China;Department of Hematological Oncology,Hebei Children′s Hospital,Hebei Shijiazhuang 050031,China;Department of Gastroenterology,Hebei Children′s Hospital,Hebei Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院药学部,河北石家庄050031 [2]河北省儿童医院血液肿瘤科,河北石家庄050031 [3]河北省儿童医院消化科,河北石家庄050031

出　　处：《中国妇幼健康研究》2022年第2期16-20,共5页Chinese Journal of Woman and Child Health Research

基　　金：河北省医学科学研究课题资助项目(20190833)。

摘　　要：目的探讨益生菌对接受大剂量甲氨蝶呤(HD-MTX)治疗急性淋巴细胞白血病(ALL)患儿的免疫功能影响及其药物经济学分析。方法选取河北省儿童医院2019年10月至2021年1月血液肿瘤科收治的113例ALL患儿为研究对象,采用随机数字表法分为观察组58例和对照组55例,两组均给予HD-MTX强化治疗,观察组患儿在此基础上给予口服双歧杆菌四联活菌片,比较两组患儿治疗后的疗效、腹泻发生情况、免疫功能[辅助性T细胞(CD4^(+))、细胞毒性T细胞(CD8^(+))、CD4^(+)与CD8^(+)比值(CD4^(+)/CD8^(+))、自然杀伤细胞(NK)],并用药物经济学方法分析比较两组成本-效果比(C/E)。结果治疗后,观察组总有效率为96.55%,对照组为92.73%,两组总有效率差异比较无统计学意义(P>0.05);观察组发生腹泻概率低于对照组,差异有统计学意义(15.52%vs.36.36%,χ^(2)=6.431,P<0.05);与对照组相比,观察组中腹泻患儿大便次数较少、大便水样状较少、病程较短,差异有统计学意义(χ^(2)值分别为10.244、2.427、7.128,P<0.05);脱水和电解质紊乱情况有所改善,但与对照组比较差异不显著(P>0.05);治疗后,观察组全血CD4^(+)、CD4^(+)/CD8^(+)、NK比例均较治疗前升高,且均高于对照组,CD8^(+)比例低于对照组,差异有统计学意义(t值分别为11.308、4.997、19.301、6.165,P<0.05);观察组每升高一个百分点所需费用为13512.97元,对照组为17748.61元,成效比为581.48,相对于对照组,观察组成本增加效果同样增加。结论益生菌可提高接受HD-MTX治疗的ALL患儿缓解率,显著降低腹泻发生率,改善患儿腹泻症状和免疫功能,具有较好疗效-成本比。Objective To explore the effect of probiotics on immune function of children patients with acute lymphoblastic leukemia(ALL)receiving high-dose methotrexate(HD-MTX)therapy and its pharmacoeconomic analysis.Methods A total of 113 children patients with ALL admitted to department of hematology and oncology of Hebei Children′s Hospital from October 2019 to January 2021 were selected as the research subjects,and they were divided into observation group(58 cases)and control group(55 cases)by using the random number table method.Both groups were given HD-MTX intensive treatment,and on this basis,children patients in observation group were given oral administration of bifidobacterium quadruple viable tablets.The efficacy,diarrhea occurrence and immune function[helper T cell(CD4^(+)),cytotoxic T cell(CD8^(+)),ratio of CD4^(+)to CD8^(+)(CD4^(+)/CD8^(+)),natural killer cell(NK)]were compared between the two groups after treatment.The cost-effectiveness ratio of the two groups was compared by pharmacoeconomic method.Results After treatment,the total effective rate was 96.55%in the observation group and 92.73%in the control group,and there was no statistically significant difference in the total effective rate between the two groups(P>0.05).The incidence rate of diarrhea in the observation group was lower than that in the control group,and the difference was statistically significant(15.52%vs.36.36%,χ^(2)=6.431,P<0.05).Compared with the control group,the number of stools was fewer,the watery stool was less and the disease course was shorter among children patients with diarrhea in the observation group,and the difference was statistically significant(χ^(2)=10.244,2.427 and 7.128,respectively,P<0.05).Dehydration and electrolyte imbalance were improved,but there were no significant differences compared to the control group(P>0.05).After treatment,the proportion of whole blood CD4^(+),CD4^(+)/CD8^(+)and proportion of NK in the observation group were significantly higher than those before treatment,and all were higher than t

关 键 词：益生菌 大剂量甲氨蝶呤 急性淋巴细胞白血病 免疫功能 药物经济学分析 

分 类 号：R733.71[医药卫生—肿瘤]