急淋白血病患儿化疗期间全身性炎症反应综合征与预后的分析

The Relation of Systemic Inflammatory Responese Syndrome and Prognosis in Children with Acute Lymphoblastic Leukemia during Chemotherapy

目的 探讨急性淋巴细胞白血病 (ALL ,急淋 )患儿化疗期全身性炎症反应综合征 (SIRS)的发生、发展与预后的关系 .方法 对ALL 42例 ,化疗 135例次接受化疗期间发生SIRS 74例次分为粒缺组和非粒缺组 .对符合SIRS诊断的在病程的第 1天进行危重评分 (PCIS评分 )、儿童死亡危险评分 (PRISM评分 ) ,并对多器官功能障碍综合征(MODS)的发生率和死亡率进行分析 .结果 ①粒缺组PCIS评分低于非粒缺组 (p <0 .0 5 ) ;粒缺组PRISM评分、MODS发生率、死亡率均高于非粒缺组 (p<0 .0 5 ) .②符合SIRS诊断标准的项目越多 ,粒缺组PCIS评分越低 (p<0 .0 5 ) ,其PRISM评分越高、MODS发生率、死亡率越高 (p <0 .0 5 ) .结论 粒细胞缺乏、符合SIRS诊断标准的项目越多、合并MODS提示预后不良 .

Objective To investigate the relationship of systemic inflammatory response syndrome(SIRS) and prognosis in children of acute lymphoblastic leukemia(ALL) during chemotherapy.Menthods 74 ALL children who were diagnosed as SIRS during chemotherapy in 1993 and 1999 were classified into agranulocytic and non-agranulocytic groups. All cases with SIRS were scored according to the criteria of pediatric critical illness score(PCIS) and pediatric risk of mortality(PRISM) in the first day of the diagnosis of SIRS, and the incidence of multiple organ dysfunction syndrome(MODS) and the mortality were analyzed.Results 1) In agranulocytic group ,the scores of PCIS was significantly lower than that of non-agranulocytic group (p<0.05); and the PRISM score, the incidence of MODS, the mortality were significantly higher than those in non-agranulocytic group(p<0.05).2)In agranulocytic group, the more the criteria of SIRS was involved, the lower PCIS scores would be; and PRISM, the incidence of MODS and the mortality would be higher.Conclusions Agranulocytosis, multiple item involved with SIRS criteria, and the incidence of MODS, all are the poor-prognostic factors in ALL children who are diagnosed from SIRS during chemotherapy.