儿童期急性白血病合并水痘的特点及其高危预后因素的临床分析

Clinical features of chickenpox and high risk factors of prognosis in childhood cases with acute lymphocytic leukemia

目的 分析儿童期急性淋巴细胞白血病（ALL）合并水痘的临床特点,探讨与预后相关的高危临床因素。方法 对2008年1月1日-2014年12月31日首都医科大学附属北京地坛医院感染中心收治的儿童期ALL合并水痘的患儿及同期随机普通水痘患儿的临床资料进行回顾性对照分析。结果仅5例（31.25%）儿童期ALL患儿合并水痘有明确水痘接触史。13例（81.25%）儿童期ALL患儿合并水痘临床表现为高热,较普通水痘患儿热程长,为（7.38±3.32）d（t=5.575,P〈0.05）;皮疹结痂时间较长,为（10.92±2.50）d（t=4.928,P〈0.05）。100%患儿出现骨髓抑制,其中10例（62.50%）患儿出现粒细胞缺乏,7例（43.75%）出现血小板减少;8例（50.00%）患儿肝功能异常。儿童期ALL患儿合并水痘经抗病毒、对症支持等治疗,临床治愈11例,自动出院4例,死亡1例。儿童期ALL患儿合并水痘临床表现危重和最终死亡者,具有应用静脉药物化疗方案治疗、化疗中或完成静脉化疗1周内罹患水痘、所有病例均出现骨髓抑制粒细胞缺乏且持续较长时间[（10.08±2.77）d]等特点。结论 儿童期ALL患儿合并水痘具有临床症状持续时间长、并发骨髓抑制粒细胞减少等特点,经积极抗病毒及对症支持治疗后预后良好。应用静脉药物化疗中或完成化疗1周内罹患水痘、持续性粒细胞缺乏是与儿童期ALL患儿并发水痘预后不良的临床相关因素。

Objective To investigate the clinical features of chickenpox and the high risk factors of the prognosis in childhood patients with acute lymphocytic leukemia （ALL）. Methods The clinical characteristics of chickenpox in childhood ALL patients hospitalized in Beijing Ditan Hospital, Capital Medical University, from January 1st, 2008 to December 31st, 2014 were studied, retrospectively, and the features of random ordinary children onset chickenpox were compared. Results There were 5 （31.25%） childhood patients with ALL had varicella virus exposure. Except one patient’s temperature was normal, the other 13 （81.25%） cases patients had higher fever and fever duration lasted for （7.38 ± 3.32） days, which signiifcantly longer than ordinary chickenpox patients （t=5.575, P〈0.05）. Skin rash scabby time were （10.92 ± 2.50） days, which signiifcantly longer than normal patients （t=4.928, P〈0.05）. All the patients （16 cases） had bone marrow suppression including agranulocytosis 10 （62.5%） cases and thrombocytopenia 7 （43.75%） cases. Patients with abnormal liver function were 8 （50.00%） cases, Skin infections in ALL patients were less than in ordinary patients. After antiviral treatment and active support treatment just like immunoglobulin, 11 patients cured, 4 cases were critically illed and discharged without and one case were died. The features of critically illed or dead cases were taking intravenous chemotherapy, onseting chickenpox during chemotherapy or just finish chemotherapy within a weeks. Granulocyte deficiency and granulocyte deficiency lasted for longer time than mild cases （10.08 ± 2.77 days）. Conclusions Longer duration of symptoms as high fever or rash and higher complication ratio of bone marrow suppression manifestated granulocytopenia were the features of chickenpox in childhood cases with ALL. Good prognosis were achieved in childhood ALL patients when proper antiviral treatment and support treatment were implemented. Taking intravenous chemotherapy, onseting chickenpox during chemotherapy or just ifnish chemotherapy within a weeks and persistent granulocyte deifciency were associated with adverse clinical prognosis in childhood cases with ALL.