阿昔洛韦联合大剂量IVIG方案治疗儿童急性白血病合并水痘的临床研究

Clinical study of acyclovir combined with high dose IVIG regimen in the treatment of childhood acute leukemia complicated with varicella

目的分析阿昔洛韦联合大剂量静脉丙种球蛋白(IVIG)方案治疗儿童急性白血病(AL)合并水痘的疗效。方法选取2016年1月1日至2018年6月1日该院感染科收治的AL合并水痘患儿30例,采用阿昔洛韦联合大剂量IVIG方案进行治疗,观察其疗效。结果 AL合并水痘患儿热程为(8.32±3.12)d,皮损结痂时间为(11.21±2.55)d,平均住院时间为(8.99±3.22)d,继发皮肤感染14例(46.67%)。患儿治愈率为100.0%。在AL合并水痘患儿中,女性患儿较男性患儿更易继发皮肤感染,差异有统计学意义(P<0.05);急性淋巴细胞白血病(ALL)合并水痘患儿热程、皮损结痂时间、住院时间均长于急性髓系白血病合并水痘患儿,差异均有统计学意义(P<0.05);ALL患儿中,诱导缓解期患儿热程长于维持治疗期患儿,继发皮肤感染率高于维持治疗期患儿,差异均有统计学意义(P<0.05)。结论儿童AL合并水痘具有临床症状持续时间长、并发化疗后骨髓抑制粒细胞减少等特点,经阿昔洛韦联合大剂量IVIG方案治疗后,其患儿预后良好、病死率低。

Objective To analyze the efficacy of acyclovir combined with high dose intravenous immunoglobulin(IVIG)regimen in the treatment of childhood acute leukemia(AL)complicated with varicella.Methods Thirty children with AL complicated with varicella admitted from January 1,2016 to June 1,2018 in the infectious department of the hospital were treated with acyclovir combined with high dose IVIG,and the therapeutic effect was observed.Results The fever course of children with AL complicated with varicella was(8.32±3.12)days,the scab formation time of skin lesions was(11.21±2.55)days,the average hospitalization time was(8.99±3.22)days,and 14 cases(46.67%)had secondary skin infections.The cure rate was 100.0%.Among children with AL complicated with varicella,female children were more susceptible to secondary skin infection than male children,and the difference was statistically significant(P<0.05);the fever course,skin scab formation time and hospitalization time of children with acute lymphoblastic leukemia(ALL)complicated with varicella were longer than those of children with acute myeloid leukemia complicated with varicella,and the differences were statistically significant(P<0.05);Among ALL children,the fever duration in induction remission period was longer than that in maintenance treatment period,and the secondary skin infection rate was higher than that in maintenance treatment period,the differences were statistically significant(P<0.05).Conclusion Childhood AL complicated with varicella has the characteristics of long duration of clinical symptoms and decrease of myelosuppressive granulocytes after chemotherapy.After treatment with aciclovir combined with high dose IVIG regimen,the prognosis of children with AL complicated with varicella is good and the mortality is low.