儿童血液系统恶性肿瘤并发肿瘤溶解综合征38例临床特点分析  

Clinical analysis of 38 cases of hematological malignancies complicated with tumor lysis syndrome in children

作　　者：王丹[1] 邵静波[1] 李红[1] 张娜 朱嘉莳 付盼 王真 WANG Dan;SHAO Jingbo;LI Hong;ZHANG Na;ZHU Jiashi;FU Pan;WANG Zhen(Department of Hematology,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200040,China)

机构地区：[1]上海市儿童医院上海交通大学医学院附属儿童医院血液科,上海200040

出　　处：《临床儿科杂志》2024年第8期684-690,共7页Journal of Clinical Pediatrics

基　　金：上海市卫生健康委员会科研课题(No.20204Y0471)。

摘　　要：目的研究儿童肿瘤溶解综合征(TLS)的临床特征和预后情况,为TLS的防治提供临床指导。方法回顾性分析2014年12月1日至2023年3月31日就诊的血液系统恶性肿瘤并发TLS患儿的临床资料,分析其临床特点及预后。结果共纳入38例TLS患儿,男27例、女11例,中位年龄6.6(2.9~9.9)岁。急性淋巴细胞白血病18例,急性髓系白血病8例,伯基特淋巴瘤12例,其中12例(31.6%)合并肾脏浸润。37例(97.4%)在化疗前24小时至化疗开始后72小时内发生TLS;符合临床TLS 21例,实验室TLS 17例。患儿发生TLS时,主要表现为急性肾损伤(AKI,20例),恶心呕吐(18例),发热(18例),胸闷、低氧血症(12例)。21例患儿因疾病加重转入PICU治疗,共发生3例TLS相关死亡。采用别嘌醇降尿酸16例,采用重组尿酸氧化酶降尿酸22例。与别嘌醇组比较,重组尿酸氧化酶组实验室TLS比例较高,AKI发生率、重症转PICU率较低,差异有统计学意义(P<0.05)。TLS发生前-3 d、TLS发生当日、TLS发生后+1 d、+3 d、+5 d共5个时间点之间别嘌醇组的LDH和尿酸水平,重组尿酸氧化酶组的LDH、尿酸和血肌酐水平差异均有统计学意义(P<0.05)。TLS发生后+1 d、+3 d、+5 d,重组尿酸氧化酶组的尿酸水平均低于别嘌醇组,差异有统计学意义(P<0.05)。结论高负荷血液肿瘤患者在治疗初期发生TLS风险高,尿酸氧化酶可有效降尿酸,减少AKI的发生,降低重症率,缩短TLS病程。Objective To study the clinical features and prognosis of tumor lysis syndrome(TLS)in children and provide clinical guidance for the prevention and treatment of TLS.Methods The clinical data of patients with TLS from December 2014 to March 2023 were retrospectively analyzed for their clinical features and prognosis.Results A total of 38 children with TLS were included,27 males and 11 females,with a median age of 6.6(2.9-9.9)years..Among these children,18 were diagnosed with acute lymphoblastic leukemia,8 with acute myeloid leukemia,and 12 with Burkitt lymphoma,of which 12 cases(31.6%)were combined with renal infiltration.37 cases(97.4%)developed TLS from 24 hours before chemotherapy to 72 hours after the start of chemotherapy,21 cases were consistent with clinical TLS,and 17 cases with laboratory TLS.The main manifestations of TLS were acute kidney injury(AKI,20 cases),nausea and vomiting(18 cases),fever(18 cases),chest tightness,and hypoxemia(12 cases).21 children were transferred to the PICU for treatment of disease exacerbation,and a total of 3 TLS-related deaths occurred.Uric acid was lowered by allopurinol in 16 cases and by recombinant uric acid oxidase in 22 cases.Compared with the allopurinol group,the recombinant uric acid oxidase group had a higher proportion of laboratory TLS and a lower incidence of AKI and severe transfer to the PICU,with statistically significant differences(P<0.05).The LDH and uric acid levels in the allopurinol group were higher at the five time points of-3 d before the onset of TLS,the same day of TLS,and+1 d,+3 d,and+5 d after TLS,and the levels in the allopurinol group were higher at the five time points of-1 d,+1 d,+3 d,and+5 d after TLS.The difference between the LDH,uric acid and blood creatinine levels in the recombinant uric acid oxidase group was statistically significant(P<0.05).The uric acid levels in the recombinant uric acid oxidase group were lower than those in the allopurinol group at+1 d,+3 d and+5 d after the onset of TLS,and the difference was statistically sign

关 键 词：恶性血液肿瘤 肿瘤溶解综合征 急性肾损伤 尿酸氧化酶 儿童 

分 类 号：R733[医药卫生—肿瘤]