儿童急性淋巴细胞白血病诱导化疗期合并脓毒症31例回顾分析

Children withacute lymphoblastic leukemia complicated with sepsisduring induction chemotherapy:retrospective analysis of 31 cases

目的:探讨儿童急性淋巴细胞白血病(ALL)诱导化疗期间合并脓毒症的病因及治疗措施。方法:回顾性分析2013年1月至2014年10月在广西医科大学第一附属医院儿科住院的31例ALL诱导化疗期间合并脓毒症患儿的临床资料。结果:126例ALL患儿中,31例出现脓毒症,脓毒症发生率为24.60%,其中治愈率为90.32%,病死率为9.68%;呼吸道是最常见的原发感染部位,病原菌以革兰阴性杆菌为主,对亚胺培南敏感率达100%;脓毒症患儿中性粒细胞缺乏及C反应蛋白(CRP)升高者均占87.10%,其中严重脓毒症和脓毒性休克组中性粒细胞计数明显低于非严重脓毒症组(P<0.05),但组间CRP水平比较差异无统计学意义(P>0.05)。结论:ALL诱导化疗期间易合并脓毒症,最常见的原发感染灶是呼吸道;化疗后粒细胞缺乏是ALL患儿化疗期间发生脓毒症的主要因素,中性粒细胞缺乏的程度可作为脓毒症严重程度的一个临床预警指标。

Objective：To investigate the pathogenesis and therapeutic methods of acute lymphoblastic leukemia （ALL） complicated with sepsis in children during induction chemotherapy. Methods. The clinical data from31 cases of ALL complicated with sepsis children during induction chemotherapy from January 2013 to November 2014in our hospital were retrospectively analyzed. Results. 31 cases of 126 ALL children were appeared sepsis （24.60% ）with a cure rate of 90.32% and mortality of 9.68%. Respiratory tract infection was the most common infection in clinic. Gram-negative bacilli were the main pathogenic bacteria. The drug susceptibility rate of the gram-negative bacteria to imipenem was 100 %. The percentages of neutrope- nia and elevated C-reactive protein （CRP） in sepsis children were both 87.10%. The neutrophil counts in severe sepsis and septic shock children were significantly lower than those in non-severe ones（ P 〈0.05）. Conclusion. The ALLchildren during induction chemotherapywere susceptible to sepsis. Respiratory tract was the common primary infection site. Agranulocytosis after chemotherapy was a key factor for sepsis and could be a predictive marker for the severityof sepsis.