摘要
目的分析CCLG-ALL2008方案治疗初诊儿童急性淋巴细胞白血病(ALL)诱导治疗期感染并发症发生情况。方法搜集2008年至2011年339例初诊儿童急性淋巴细胞白血病(ALL)在诱导治疗期感染情况并进行分析,评价标危组(SR)、中危组(MR)、高危组(HR)间感染差异、常见感染部位、感染病原体分布。结果303例患儿完成诱导治疗,36例未进入统计范围,包括16例曾院外治疗,10例诊断后放弃治疗,7例在诱导治疗中期放弃治疗(其中3例患儿初诊时伴有肺炎),2例混合白血病,1例T细胞型且合并肾衰竭放弃治疗。SR 151例,男96例,女55例,性别比1.75:1,中位年龄4(1~9)岁;MR 81例,男46例,女35例,性别比1.31:1,中位年龄6岁(6个月~14岁);HR 71例,男47例,女24例,性别比1.96:1,中位年龄10(1~15)岁。195例患儿诱导期出现感染,总感染率为64.36%(195/303),三组感染率分别为64.9%,64.19%,63.38%,差异无显著性(P=0.996)。感染相关死亡率3.63%(11/303)。110例患儿感染部位明确(110/195,56.41%),发生频率依次为呼吸道、血液、口腔、消化道、皮肤和软组织,发生率分别为82.72%、30%、11.82%、6.32%、2.72%。疑似真菌感染37.43%(73/195),病原菌明确的感染为42例次(42/110,38.18%),G菌感染29例次(29/41,70.73%),G^+菌感染12例次(12/41,29.27%),真菌感染1例。常见病原菌依次为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌。结论CCLG-ALL 2008诱导化疗在各组间的感染率无显著差异;感染部位以呼吸道为主;病原菌种类以G^-为主;感染多发生在诱导治疗中期;低龄患儿、粒缺及粒缺持续时间是感染高危因素,感染无性别差异。
Objective To analyze the incidence of infection complications during induction therapy in newly diagnosed childhood acute lymphoblastic leukemia treated with CCLG-2008 protocol.Methods A total of 339 newly diagnosed children with acute lymphoblastic leukemia（ALL） from 2008 to 2011 were enrolled in this study, the infection complication at the stage of induction therapy was analyzed, the differences of infection, common infection sites and infection pathogens distribution in the standard risk group（ SR）, moderate risk group（MR） and high risk group（HR） were evaluated.Results A total of 303 patients（ 303/339 patients） completely finished the induction therapy, 36 patients were not involved in the statistical range, including 16 patients who had extramural hospital treatment, 10 patients gave up treatment after diagnosed, and 7 patients gave up treatment in the middle of induction therapy（3 cases were primarily diagnosed with pneumonia）, 2 cases were hybrid leukemia,1 case was T cell type, who gave up treatment when renal failure occurred. 151 cases in SR, 96 were males and 55 were females, gender ratio was 1. 75 ： 1, the median age was 4 years old（1-9 years old）;81 cases in MR, 46 were males and 35 were females, gender ratio was 1.31 ： 1, the median age was 6 years old（6 months old to 14 years old）; 71 cases in HR, 47 were males and 24 were females, gender ratio was 1. 96 ： 1, the median age was 10 years old（ 1-15 years old）. Among them, 195 cases appeared infection during the induction stage, the overall infection rate was 64. 36%（ 195/303 cases）, and the infection rates were 64. 9%, 64. 19% and 63. 38%, respectively, which had no significant differences（P= 0.996）. Infection-related mortality was 3. 63%（11/303）. The location of infection was definite in110 cases（ 110/195,56. 41%）. The frequency of infection occurrence was respiratory tract, blood, oral cavity, digestive tract, skin and soft tissue. The incidence was 82. 72%, 30%, 11.82%, 6. 32% and2. 72%, respectively. Suspected fungal infection was 37.43%（73/195）. The specific infection of the confirmed pathogen was 42 cases（42/110, 38. 18%）; 29 cases were G-infection（29/41, 70. 73%）;12 cases were G ＋ infection（ 12/41, 29. 21%）;1 case was fungal infection. Common pathogens followed by as Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa. Conclusions There was no significant difference in the infection rate among different groups under CCLG-2008 protocol. The location of infection was mainly respiratory tract, the main pathogenic bacteria was G-, the infection was mainly occurred at the metaphase of induction therapy. Among younger children patients,the duration of granulocyte deficiency and granulocyte deficiency were high risk factors for infection, and there was no difference in both genders.
出处
《中国小儿血液与肿瘤杂志》
CAS
2017年第6期286-291,共6页
Journal of China Pediatric Blood and Cancer
关键词
急性淋巴细胞白血病
儿童
诱导化疗
感染
Acute lymphoblastic leukemia, Children
Induction chemotherapy
Infection
