儿童血液系统肿瘤并发肿瘤溶解综合征40例病例系列报告

Tumor lysis syndrome in 40 children with hematological malignancies:A case series report

目的探讨肿瘤溶解综合征(TLS)的临床特点及防治措施,为TLS的综合管理提供依据。方法回顾性总结2016年4月至2019年4月就诊于首都医科大学附属北京儿童医院的TLS患儿的临床资料,包括临床特征、化疗前后辅助检查结果、治疗和预后。结果 40例患儿进入本文分析,男28例(70%),女12例,年龄1.0~16.3岁,急性白血病8例,非霍奇金淋巴瘤32例。34例(85%)患儿在化疗开始72 h内发生TLS。40例患儿中,恶心、呕吐2例(5%),发热、乏力2例(5%),胸闷、喘憋7例(17.5%),腹痛3例(7.5%),尿量减少、水肿6例(15%),手足搐搦5例(12.5%)。实验室检查提示高钾血症4例(10%),高磷血症26例(65%),低钙血症12例(30%),高尿酸血症37例(92.5%)。尿酸氧化酶和传统药物别嘌呤醇在降低尿酸(78.6%vs 49.9%)与急性肾损伤(AKI)的发生率(4.3%vs 25.0%)差异有统计学意义。结论血液肿瘤患者在化疗初期容易发生TLS,应密切监测生化指标,积极水化及纠正电解质紊乱。尿酸氧化酶有效降低AKI的发生率,降低化疗初期的病死率。

Objective To investigate clinical manifestations and preventive measures of tumor lysis syndrome(TLS)and to provide the basis for the integrated management of TLS.Methods A retrospective analysis was performed on the clinical data including the clinical characteristics,auxiliary examination results before and after chemotherapy,treatment and prognosis from children with TLS treated in Beijing Children's Hospital from April 2016 to April 2019.Results A total of 40 patients at the age of 1 to16.3 years were included into the analysis with 28 males(70%)and 12 females.Among them,there were 8 cases of acute leukemia and 32 cases of non⁃Hodgkin's lymphoma.Thirty⁃four cases(85%)occurred TLS within 72 hours.Of 40 cases,2 cases(5%)had nausea and vomiting,2 cases(5%)had fever and fatigue,7 cases(17.5%)had chest congestion and dyspnea,3 cases(7.5%)had abdominal pain,6 cases(15%)had low urine output and edema,and 5 cases(12.5%)had tetany.Laboratory tests showed there were 4 cases of hyperkalemia(10%),26 cases of hyperphosphatemia(65%),12 cases of hypocalcemia(30%)and 37 cases of hyperuricemia(92.5%).The differences between the effect of uric acid oxidase and allopurinol on reducing the level of uric acid(78.6%vs 49.9%)and the incidence of acute kidney injury(AKI)(4.3%vs 25%)were statistically significant.Conclusion Patients with hematological malignancies are prone to developing TLS in the early stage of chemotherapy.Biochemical indicators should be closely monitored in order to perform hydration and correct electrolyte disorders timely.Uric acid oxidase can effectively reduce the incidence of AKI and the mortality in the early stage of chemotherapy for patients with hematological malignancies.