急性淋巴细胞白血病患儿在诱导缓解期的营养不良状况调查

Analysis of malnutrition status in pediatric acute lymphoblastic leukemia patients during the induced remission stage

目的:了解儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)诱导缓解期的营养不良状况;分析ALL诱导缓解期间疾病本身、治疗、并发症对患儿营养不良状况的影响。方法:分析2016年12月至2017年12月贵州医科大学附属医院儿童血液肿瘤科行诱导缓解方案的ALL患儿病历资料,选取40例患儿作为研究对象,收集患儿基本信息,分别于诱导缓解治疗的第1天、第15天、第33天监测患儿的身高、体质量、计算体质指数(boby mass index,BMI),并同时检测血清白蛋白、血清前白蛋白等实验室检查结果,采用SPSS 23.0软件进行数据分析。结果:40例ALL患儿中,诱导缓解治疗第1天存在营养不良16例(40.0%),治疗第15天14例(37.0%),第33天14例(37.0%);在营养不良的患儿中,诱导缓解治疗第1天发生中重度营养不良4例(25.0%),第15天9例(64.3%),第33天12例(85.7%);第1天和第33天比较差异具有统计学意义(P<0.017)。在诱导缓解期监测BMI,第1天BMI为15.98±2.17、第15天为15.65±2.20、第33天为15.66±1.92,三者间比较差异无统计学意义(P=0.730)。对患儿营养状况相关因素的单因素进行分析,感染、消化系统受累、血清白蛋白水平与营养不良的发生有关,同时对这3个因素进行多因素分析,感染和血清白蛋白水平与营养不良的发生间差异具有统计学意义(P<0.05)。结论:在诱导缓解期间部分ALL患儿营养不良程度加重,感染是ALL患儿发生营养不良的高危因素,血清白蛋白水平下降可提示营养不良的发生,对患儿进行动态的营养状况监测十分必要。

Objective： To investigate the nutritional status of children acute lymphoblastic leukemia（ALL） during induced remission stage. The effects of the disease itself, treatment, and complications of malnutrition were all analyzed. Methods： From the medical records of children with ALL in the pediatric hematological department of the Affiliated Hospital of Guizhou Medical University, we collected basic information of the children; monitored the height and weight of the children on the first, 15 th, and 33 rd days of induced remission treatment; and calculated their body mass index（BMI）, as well as results of laboratory tests such as serum albumin and serum prealbumin. SPSS 23.0 software was used for data analysis. Results： In 40 children with ALL, there were 16 cases of malnutrition on the first day of induced remission treatment accounting for 40%, 14 cases on both the 15 th day and the 33 rd day of treatment accounting for 35%. Among children with malnutrition, 4 cases of moderate to severe malnutrition occurred on the first day of treatment accounting for 25.0%, 9 cases on the 15 th day accounting for 64.3%, and 12 cases on the 33 rd day accounting for 85.7%. Compared with day 1 and day 33, the difference was statistically significant（P〈0.017）. In the induced remission period, the BMI on the first day was（15.98±2.17） kg/m2; on the 15 th day, it was（15.65±2.20） kg/m2; and on the 33 rd day, it was（15.66±1.92） kg/m2. The difference between the three was not statistically significant（P=0.730）. In the single-factor analysis of factors related to the nutritional status of children, infection, digestive system involvement, and serum albumin levels were related to the occurrence of malnutrition, and we performed multifactor analysis of these three factors. The difference between the level of infection and serum albumin and the occurrence of malnutrition was statistically significant（P〈0.05）. Conclusions： During the induced remission, the malnutrition degree of some children with ALL was aggravated. Infection was a high-risk factor for malnutrition in children with ALL. The decrease in serum albumin level may indicate the occurrence of malnutrition. Dynamic monitoring of nutritional status in children with ALL is necessary.