拉布立酶对重症晚期Burkitt′s淋巴瘤患儿预后的影响

Efficacy of Rasburicase for critically ill children with advanced Burkitt′s lymphoma

目的探讨拉布立酶对重症晚期Burkitt′s淋巴瘤患儿预后的影响。方法回顾性分析2015年1月至2020年5月中山大学附属第一医院儿科重症监护室收治的晚期Burkitt′s淋巴瘤患儿临床资料,根据患儿降尿酸治疗方案分为拉布立酶组和传统治疗组,比较2组降尿酸治疗的效果及预后。结果共纳入晚期Burkitt′s淋巴瘤患儿29例,其中Ⅲ期13例(44.83%),Ⅳ期16例(55.17%)。就诊时最常见的症状为腹胀或发现腹部包块(13例,44.83%),其次为腹痛(7例,24.14%)。原发肿瘤最常见于腹盆腔(21例,72.41%),其次为头颈部(6例,20.69%)。拉布立酶组15例,传统治疗组14例,2组患儿入院时血肌酐、乳酸脱氢酶、尿酸水平差异均无统计学意义(均P>0.05)。拉布立酶组患儿治疗24 h、72 h后血尿酸恢复正常的比例明显高于传统治疗组(85.71%比25.00%,100.00%比25.00%),差异均有统计学意义(均P<0.01)。2组患儿肿瘤溶解综合征发生率差异无统计学意义(33.33%比64.29%,P=0.096),但拉布立酶组急性肾损伤发生率、需肾替代治疗率、严重并发症发生率、28 d死亡率均明显低于传统治疗组(33.33%比85.71%,13.33%比64.29%,20.00%比78.57%,0比35.71%),差异均有统计学意义(均P<0.05)。结论拉布立酶可有效降低重症晚期Burkitt′s淋巴瘤患儿血尿酸水平,减少急性肾损伤及严重并发症的发生,改善患儿预后。

Objective To explore the efficacy and safety of Rasburicase therapy in critically ill children su-ffering from advanced Burkitt′s lymphoma.Methods A retrospective analysis of children with advanced Burkitt′s lymphoma was admitted to Pediatric Intensive Care Unit,the First Affiliated Hospital of Sun Yat-Sen University,from January 2015 to May 2020 and accepted treatment.According to the uric acid-lowering therapies,patients were divided into 2 groups,namely Rasburicase group(Group R)and traditional treatment group(Group T),to compare the effects of hypouricemic treatment and the prognosis between the 2 groups.Results Twenty-nine children with advanced Burkitt′s lymphoma were included in this study,with 13 cases(44.83%)of stageⅢand 16 cases(55.17%)of stageⅣ.Abdominal mass/abdominal distension(13 cases,44.83%)and abdominal pain(7 cases,24.14%)were the main reasons of initial medical visit attendance.The most common primary tumor site was abdominal/pelvic cavity(21 cases,72.41%),followed by head or neck(6 cases,20.69%).There were 15 cases in Group R and 14 cases in group T.No significant differences in serum creatinine,lactate dehydrogenase and uric acid were detected between the 2 groups(all P>0.05).The proportion of serum uric acid recovery rate of 24 hours and 72 hours after initial treatment in Group R were significantly higher than those in T group(85.71%vs.25.00%,100.00%vs.25.00%,all P<0.01).Although there were no obvious differences in the incidence of tumor lysis syndrome between the 2 groups(33.33%vs.64.29%,P=0.096),the incidence of acute renal injury,renal replacement therapy requirement,serious complications and the 28 day mortality in Group R were remarkably lower than those in Group T(33.33%vs.85.71%,13.33%vs.64.29%,20.00%vs.78.57%,0 vs.35.71%,all P<0.05).Conclusions Rasburicase can effectively reduce the serum uric acid level and decrease the incidence of acute kidney injury and other severe complications,thus improving the prognosis of children experiencing advanced Burkitt′s lymphoma.