儿童重症监护室类白血病反应患儿的临床特征及预后分析  

Clinical characteristics and prognosis analysis of children with leukemoid reaction in pediatric intensive care unit

作　　者：饶小平[1] 邬涛 蔡丹 RAO Xiaoping;WU TaoCAI Dan(Pediatric Intensive Care Unit,Jiangxi Provincial Children's Hospital,Jiangxi Province,Nanchang330000,China)

机构地区：[1]江西省儿童医院儿童重症监护室,江西南昌330000

出　　处：《中国当代医药》2024年第31期71-74,共4页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202311007)。

摘　　要：目的分析儿童重症监护室(PICU)类白血病反应(LR)患儿的临床特征及预后。方法回顾性分析2022年4月至2023年12月江西省儿童医院PICU收治的LR患儿的临床资料,收集患儿基线资料(性别、年龄)、临床症状、实验室指标[白细胞(WBC)、嗜中性粒细胞(N)、淋巴细胞(L)、血红蛋白(Hb)、血小板(PLT)、C反应蛋白(CRP)、降钙素原(PCT)]、病原学检测结果(病原全阴性、单一感染、混合感染)及转归情况。根据患儿预后情况分为存活组(n=45)和死亡组(n=22),比较两组患儿临床资料差异,采用单因素及多因素logistic回归分析影响LR患儿预后的危险因素。结果共纳入67例PICU LR患儿,其中45例(67.16%)存活,22例(32.84%)死亡,单因素分析结果显示,入院时WBC、CRP、PCT检测水平与PICU LR患儿预后有关,差异有统计学意义(P<0.05);两组患儿性别、年龄、临床症状、抗生素使用情况、入院时及入院第3天的N、L、Hb、PLT水平比较,差异均无统计学意义(P>0.05);两组患儿单一感染和混合感染均以巨细胞病毒(CMV)感染为主,存活组以单一感染为主,共25例(55.56%),死亡组以混合感染为主,共10例(45.45%),死亡组中以CMV和其他病原体的混合感染为主,共8例;存活组和死亡组病原学检测情况比较,差异有统计学意义(P<0.05);采用logistic回归模型进行多因素分析,结果显示,入院时WBC(β=0.864,OR=2.373,95%CI:1.694~3.324)、CRP(β=1.231,OR=3.425,95%CI:1.104~8.371)是PICU LR患儿预后的独立危险因素(P<0.05)。结论入院时WBC、CRP、PCT检测水平和病原学检测情况是PICU LR患儿预后的影响因素,入院时WBC、CRP水平是PICU LR患儿预后的独立危险因素,有望成为临床诊治参考。Objective To analyze the clinical features and prognosis of children with leukemoid reaction(LR)in pediatric intensive care unit(PICU).Methods Clinical data of LR children admitted to PICU of Jiangxi Children's Hospital from April 2022 to December 2023 were retrospectively analyzed.Baseline data(gender,age),clinical symptoms,laboratory indicators(white blood cell[WBC],neutrophil[N],lymphocyte[L],hemoglobin[Hb],platelet[PLT],C-reactive protein[CRP],procalcitonin[PCT]),etiological test results(total negative,single infection,mixed infection)and outcome situation were collected.According to the prognosis,the children were divided into survival group(n=45)and death group(n=22).The difference of clinical data between the two groups was compared,and the risk factors affecting the prognosis of LR children were analyzed by univariate and multivariate logistic regression.Results A total of 67 children with LR in PICU were included,of which 45(67.16%)survived and 22(32.84%)died.The results of univariate analysis showed that WBC,CRP and PCT detection levels were correlated with the prognosis of PICU LR children,and the differences were statistically significant(P<0.05).There were no significant differences in gender,age,clinical symptoms,antibiotic use,N,L,Hb and PLT levels at admission and the 3rd day after admission between the two groups(P>0.05).Cytomegalovirus(CMV)infection was the main infection in both the single infection and the mixed infection in the two groups.In the survival group,the single infection(25 cases[55.56%])was the main infection,in the death group,the mixed infection(10 cases[45.45%])was the main infection.The mixed infection of CMV and other pathogens was the main infection in the death group,with a total of 8 cases.There was statistical significance in etiological detection between survival group and death group(P<0.05).Multivariate analysis using logistic regression model showed that WBC(β=0.864,OR=2.373,95%CI:1.694-3.324),CRP(β=1.231,OR=3.425,95%CI:1.104-8.371)were an independent risk factors fo

关 键 词：类白血病反应 临床特征 病原检测 儿童 

分 类 号：R725.5[医药卫生—儿科]