神经母细胞瘤高危组患儿化学治疗后外周血细胞改变及严重感染相关因素的分析

Changes of the peripheral blood cells in children with high-risk neuroblastoma after chemotherapy and factors related to severe infection

目的·研究神经母细胞瘤高危组患儿化学治疗(化疗)后外周血中性粒细胞和淋巴细胞的水平、严重感染率及与化疗组合的关系,为高危组患儿化疗后预防感染提供指导。方法·分析自2012年7月至2015年9月在上海交通大学医学院附属新华医院首诊住院的神经母细胞瘤高危组患儿45例,记录化疗方案及化疗后反应,记录化疗第1、第5、第10、第15及第20日的中性粒细胞及淋巴细胞绝对值,随访并记录化疗后的感染情况,进行统计学分析。结果·化疗后中性粒细胞及淋巴细胞在每轮化疗第10日左右降至最低,第15日左右上升。感染发生与第10日的中性粒细胞(r=-0.245)及淋巴细胞(r=-0.227)数量呈负相关。淋巴细胞在4轮化疗后进入持续性淋巴细胞缺乏期。神经母细胞瘤高危组化疗后Ⅳ级骨髓抑制达90.0%,严重感染率达15.5%,3个化疗药物组合之间在Ⅲ级(P=0.008)和Ⅳ级骨髓抑制(P=0.001)及严重感染发生方面(P=0.010)差异统计学意义。结论·神经母细胞瘤高危组儿童化疗后有明显的骨髓抑制和较高的感染发生率,尤其是环磷酰胺+阿霉素+长春新碱组合,需重视此组儿童化疗的耐受度,积极采取措施以降低严重感染率。

Objective · To investigate the changes of neutrophils and lymphocytes during chemotherapy courses in children with high-risk neuroblastoma, as well as severe infection rate and its relationship with combination chemotherapy regimens in order to provide guidance to prevent infection in these children. Methods · A total of 45 cases of children with high-risk neuroblastoma, who were hospitalized in Xinhua Hospital from July 2012 to September 2015 were recruited. Reactions after chemotherapy and the results of routine blood tests on every 5 days during the whole chemotherapy circles were recorded. Follow-up visits were carried out to learn the infection occurrence. Results · The counts of neutrophils and lymphocytes dropped to the minimum at the 10th day or so during chemotherapy, then rised near the 15th day. Infections were negatively correlated with the numbers of neutrophils （r =-0.245） and lymphocytes （r =-0.227） at the 10th day. Persistent lymphopenia occured after the forth course of chemotherapy. Rate of grade Ⅳ bone marrow suppression after chemotherapy was 90%, and severe infection rate was 15.5%. There were significant differences in the rates of grade Ⅲ bone marrow suppression （P=0.008）, grade Ⅳ bone marrow suppression （P=0.001） and severe infection （P=0.010） among the 3 combination chemotherapy regimens used in high-risk neuroblastoma children. Conclusion · Children with high-risk neuroblastoma had obviously high rates of bone marrow suppression and severe infection after chemotherapy, especially after cyclophosphamide＋doxorubicin＋vincristine regimens. More attention should be paid to this group of children and preventive measures were worthy of taking into account.