儿童急性B淋巴细胞白血病合并化疗诱导周围神经病变的临床特点及预后分析  

Clinical characteristics and prognosis of acute B-lymphoblastic leukemia complicated with chemotherapy-induced peripheral neuropathy in children

作　　者：周昕羽 汤继宏[1] 肖潇 冯隽 杨乐天 徐欢 武银银 ZHOU Xinyu;TANG Jihong;XIAO Xiao;FENG Jun;YANG Letian;XU Huan;WU Yinyin(Department of Neurology,Children′s Hospital Affiliated to Soochow University,Suzhou 215025,China)

机构地区：[1]苏州大学附属儿童医院神经内科,江苏苏州215025

出　　处：《基础医学与临床》2024年第10期1394-1399,共6页Basic and Clinical Medicine

基　　金：苏州市科技计划项目(SKY2022007)。

摘　　要：目的总结急性B淋巴细胞白血病(B-ALL)患儿发生化疗诱导的周围神经病变(CIPN)特征,探讨CIPN发生及预后的危险因素。方法回顾性分析2020年6月至2023年12月苏州大学附属儿童医院血液肿瘤科29病区收治的接受化疗并已结束化疗6个月的60例B-ALL患儿的临床资料。结果B-ALL合并CIPN共37例,CIPN发生率为61.7%;发病年龄增加是儿童发生CIPN的危险因素[OR=1.209,95%CI(1.023~1.428),P=0.026];感觉神经功能障碍发生率(78.4%)最高;肌电图检查提示B-ALL合并CIPN为具有一定可逆性的多发性周围神经源性损害;化疗各阶段中在诱导期出现CIPN的有13例(35.1%),占比最高;结束化疗后6个月CIPN好转率67.6%,发病年龄[OR=2.418,95%CI(0.212~2.106),P=0.018]及CIPN严重程度[OR=203.394,95%CI(2.29~18065.04),P=0.02]为CIPN患儿预后的危险因素,发病年龄越大、CIPN严重程度越高,预后较差。结论B-ALL患儿合并CIPN为可逆性多发性周围神经损害,CIPN的发生及转归可能与患儿的个体差异有关。Objective To summarize the characteristics of chemotherapy-induced peripheral neuropathy(CIPN)in children with acute B-lymphoblast leukemia(B-ALL)and to identify the influencing factors and prognosis of CIPN.Methods The clinical data of 60 children with B-ALL admitted to the 29th Ward of the Department of Hematology and Oncology,Children′s Hospital Affiliated to Soochow University from June 2020 to December 2023 who received chemotherapy and had finished chemotherapy for 6 months were retrospectively reviewed.Results There were 37 cases of B-ALL combined with CIPN;the incidence of CIPN was 61.7%.Increasing age of onset was a risk factor for CIPN in children[OR=1.209,95%CI(1.023-1.428),P=0.026]with the highest incidence of sensory nerve dysfunction(78.4%).Electromyography indicated that B-ALL combined with CIPN was multiple peripheral neurogenic lesions with certain reversibility.In the induction stage of chemotherapy,13 cases(35.1%)showed CIPN,accounting for the highest proportion.The CIPN improvement rate 6 months after chemotherapy was 67.6%,the age of onset[OR=2.418,95%CI(0.212-2.106),P=0.018]and the severity of CIPN[OR=203.394,95%CI(2.29-18065.04).P=0.02]were risk factors for poor prognosis of children with CIPN.The older the age of onset was,the higher the severity of CIPN and worse prognosis were found.Conclusions Children with B-ALL complicated with CIPN are reversible multiple peripheral nerve lesions,and the occurrence and outcome of CIPN is potentially related to individual differences of children.

关 键 词：儿童急性B淋巴细胞白血病 化疗诱导的周围神经病变 危险因素 临床表现 预后 

分 类 号：R725.9[医药卫生—儿科]