儿童急性淋巴细胞白血病诱导缓解期并发严重感染的临床分析  

Clinical analysis of severe infections in pediatric patients with acute lymphoblastic leukemia during induction period

作　　者：刘畅 付文凤 张姮 薛瑶 方拥军[1] LIU Chang;FU Wenfeng;ZHANG Heng;XUE Yao;FANG Yongjun(Department of Hematology and Oncology,the Affiliated Children’s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院血液肿瘤科,江苏南京210008

出　　处：《南京医科大学学报（自然科学版）》2023年第9期1239-1244,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省卫生健康委员会基金(ZDB2020018)。

摘　　要：目的:探讨儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)诱导缓解期感染的临床特点,分析发生严重感染的危险因素,为临床干预提供理论依据。方法:回顾性分析2020年6月—2022年6月于南京医科大学附属儿童医院诊治的ALL患儿188例,均采用CCCG-ALL-2020方案化疗,重点采集患儿诱导缓解期并发感染的临床资料,对感染部位、致病菌和严重感染危险因素进行分析。结果:180例(95.7%)ALL患儿诱导缓解期发生感染,感染部位/原因前3位分别为不明原因感染(28.4%)、上呼吸道感染(23.6%)、下呼吸道感染(16.9%)。48例(26.7%)患儿发生严重感染,23.8%(43/180)的患儿经历了微生物学记录的感染,G-菌与G+菌的比例相当。严重感染组住院时长、住院费用、单位体表面积抗生素费用均显著高于非严重感染组(P<0.05)。中高危(OR=2.804,95%CI:1.234~6.375,P=0.014)、血清白蛋白<35 g/L(OR=4.708,95%CI:2.067~10.726,P=0.001)、中性粒细胞缺乏持续时间>7 d(OR=3.697,95%CI:1.393~9.816,P=0.009)是诱导缓解期发生严重感染的独立危险因素。结论:感染在ALL诱导缓解期高发,中高危、血清白蛋白<35 g/L、中性粒细胞缺乏持续时间>7 d是诱导缓解期发生严重感染的独立危险因素,应针对性采取有效的预防措施。Objective:To investigate the clinical characteristics in pediatric patients with acute lymphoblastic leukemia(ALL)during induction period,analyze the risk factors of severe infections,in order to provide theoretical basis for clinical intervention.Methods:A retrospective analysis was conducted for the clinical data of 188 pediatric patients underwent CCCG⁃ALL⁃2020 protocol with newly⁃diagnosed ALL from June 2020 to June 2022 in the Affiliated Children’s Hospital of Nanjing Medical University.The distribution of infections,pathogenic bacteria and susceptible factors of severe infections were analyzed during induction period.Results:The incidence of infection among pediatric patients with ALL during induction period was 95.7%(180/188)with unknown infections being the most common(28.4%),followed by upper respiratory tract infections(23.6%)and lower respiratory tract infections(16.9%).Forty⁃eight cases(26.7%)of the patients developed severe infections,while 23.8%(43/180)experienced micro⁃biographically documented infections,in which Gram⁃negative and Gram⁃positive bacteria were equally represented.The duration of hospitalization,hospitalization expenses and antibiotic cost per unit body surface area were significantly greater in severe infection group,compared with the non⁃severe infection group(P<0.05).Medium⁃high risk(OR=2.804,95%CI:1.234-6.375,P=0.014),serum albumin<35 g/L(OR=4.708,95%CI:2.067-10.726,P=0.001)and duration of agranulocytosis>7 days(OR=3.697,95%CI:1.393-9.816,P=0.009)were ascertained as independent risk factors for severe infection during induction period.Conclusion:Infection was most frequently observed during induction period of ALL.Independent risk factors for severe infections included medium⁃high risk,serum albumin<35 g/L and duration of agranulocytosis>7 days.It is imperative to implement appropriate preventive measures.

关 键 词：感染 急性淋巴细胞白血病 诱导缓解期 儿童患者 危险因素 

分 类 号：R733.71[医药卫生—肿瘤]