52例儿童急性淋巴细胞白血病诱导期合并败血症临床分析

Clinical Analysis of 52 Cases of Sepsis during the Induction Chemotherapy Period in Childhood Acute Lymphoblastic Leukemia

目的分析儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)诱导期合并败血症患儿的临床特点及预后因素。方法收集2018年6月~2021年6月入住复旦大学附属儿科医院安徽医院(安徽省儿童医院)血液科的初诊ALL患儿共192例,对诱导期合并败血症的52例患儿的临床资料进行回顾性分析,包括临床特点、病原学资料、实验室检查及治疗转归等。结果52例败血症患儿中,男性31例,女性21例,中位年龄为4(1~13)岁,病程中均有发热症状。最常见的血流外感染部位是肺部,其次是口腔黏膜及消化道。共分离出G+菌16株、G-菌36株,分别以肺炎链球菌、大肠杆菌为主要菌种。经积极抗感染治疗后最终存活43例,死亡9例。存活组和死亡组患儿的实验室检查指标血清白蛋白、C反应蛋白(CRP)、降钙素原(PCT)水平及诱导期粒细胞缺乏持续天数比较,差异有统计学意义(P分别为0.012、0.001、0.037、0.040)。结论ALL诱导期合并败血症者患儿以G-菌感染为主,白蛋白、CRP、PCT水平及粒细胞缺乏持续天数可能与不良预后相关。

Objective To explore the clinical characteristics and prognostic factors of pediatric acute lymphoblastic leukemia(ALL)with sepsis during induction chemotherapy period.Methods A total of 192 patients with pediatric ALL admitted to the hematology department from June 2018 to June 2021 were enrolled,and the clinical characteristics,pathogenic strains,laboratory data and therapeutic outcomes of 52 cases of sepsis during the induction chemotherapy period were retrospectively analyzed.Results Among the 52 cases,31 were male and 21 were female,and the age at diagnosis was 4(1-13)years old.All sepsis patients developed fever.The most common site of infection were the lungs,followed by the oral mucosa and digestive tract.A total of 16 strains of Gram-positive bacteria and 36 strains of Gram-negative bacteria were cultivated.Streptococcus pneumoniae was the most common Gram-positive pathogens while Escherichia coli was the most common Gram-negative pathogens.43 cases survived and 9 cases died after anti-infective therapy and supportive treatment.There were statistically significant differences in albumin,C-reactive protein(CRP),procalcitonin(PCT)and duration of neutropenia between survival group and death group(P were 0.012,0.001,0.037,0.040).Conclusion Gram-negative bacteria are the most common pathogenic bacteria in pediatric ALL with sepsis during induction chemotherapy period,and hypoproteinemia,CRP,PCT and duration of neutropenia may be related to poor prognosis.