儿童急性淋巴细胞白血病并发急性胰腺炎的危险因素分析

Analysis of risk factors in acute lymphoblastic leukemia complicated with acute pancreatitis in children

目的分析儿童急性淋巴细胞白血病(ALL)并发急性胰腺炎(AP)的危险因素。方法回顾性研究。选取2018年5月至2020年12月首都医科大学附属北京儿童医院血液病中心收治的ALL并发AP患儿39例作为病例组, 同期按照同年龄、同性别1∶2完全匹配的方式随机选取78例ALL患儿作为对照组。2组计量资料比较采用秩和检验(Mann-Whitney U检验), 计数资料比较采用χ^(2)检验, 并进一步行多因素Logistic回归分析寻找ALL并发AP的危险因素, 同时探究各指标与严重程度的关联。结果 ALL并发AP的发病率为8.55%(39/456例), 3~10岁为高发年龄段。64.9%(24/37例)发生在早期化疗阶段, 66.7%(26/39例)与门冬酰胺酶相关。2组患儿的ALL危险分层(χ^(2)=21.404, P<0.001)、C反应蛋白(CRP)(U=232.000, P<0.001)、降钙素原(PCT)(t=3.950, P<0.001)、红细胞比容(t=3.981, P<0.001)、血钙(t=-9.609, P<0.001)、未结合胆红素(U=1 142.000, P<0.05)、三酰甘油(t=3.600, P=0.001)、白蛋白(t=-6.296, P<0.001)比较差异均有统计学意义。病例组腹部CT敏感性为70.8%, 腹部超声敏感性为81.6%, 胰腺磁共振成像(MRI)敏感性为100.0%。多因素Logistic回归分析显示, 白蛋白(OR=11.444, 95%CI:3.240~40.423)、三酰甘油(OR=18.047, 95%CI:5.020~65.074 )及危险分层(OR=8.894, 95%CI:1.889~41.885)的差异有统计学意义。重度胰腺炎患儿与轻度或中度重症胰腺炎患儿之间的PCT(U=3.000、2.000, 均P<0.05)、血钙(U=4.500、8.500, 均P<0.05)差异显著。结论 ALL并发AP多发生在化疗早期, 主要由门冬酰胺酶所致。影像学检查中胰腺MRI敏感度最高, 腹部超声次之。危险分层、白蛋白下降、三酰甘油升高是ALL并发AP的危险因素, 有助于对ALL并发AP的高危患儿进行早期识别。PCT与血钙水平可能对重度胰腺炎有提示作用。

Objective To analyze the early risk warning factors of clinical characteristics in children with acute lymphoblastic leukemia(ALL)complicated with acute pancreatitis(AP).Methods Retrospective study.A total of 39 children with ALL complicated with AP admitted to the Hematology Center of Beijing Children′s Hospital,Capi-tal Medical University from May 2018 to December 2020 were selected as the case group,and 78 ALL patients were randomly selected as the control group according to the exact matching of 1∶2 of the same age and sex.The measurment data and counting data were analyzed by Rank sum test(Mann Whitney U test)andχ^(2) test between the 2 groups,respectively,and further multivariate Logistic regression analysis was performed to find out the risk factors of ALL complicated with pancreatitis.At the same time,the relationship between each index and severity was explored.Results The incidence of ALL complicated with AP was 8.55%(39/456 cases).The high incidence age was 3-10 years old.Sixty-four point nine percent(24/37 cases)of the pancreatitis occurred in the early stage of chemotherapy,and 66.7%(26/39 cases)was associated with asparaginase.There were significant differences in ALL risk stratification(χ^(2)=21.404,P<0.001),C-reactive protein(CRP)(U=232.000,P<0.001),procalcitonin(PCT)(t=3.950,P<0.001),hematocrit(t=3.981,P<0.001),serum calcium(t=-9.609,P<0.001),indirect bilirubin(U=1142.000,P<0.05),triglyceride(t=3.600,P=0.001)and albumin(t=-6.296,P<0.001)between the 2 groups.The sensitivity of abdominal CT,abdominal ultrasound and pancreatic magnetic resonance imaging in the case group were 70.8%,81.6%and 100.0%,respectively.Multivariate Logistic regression analysis showed that differences between albumin(OR=11.444,95%CI:3.240-40.423),triglyceride(OR=18.047,95%CI:5.020-65.074)and risk stra-tification(OR=8.894,95%CI:1.889-41.885)were statistically significant,and there were obvious differences in PCT(U=3.000,2.000,all P<0.05)and serum calcium(U=4.500,8.500,all P<0.05)between patients with severe pancreatitis and patients with mild or moderate severe pancreatitis.Conclusions ALL complicated with AP often occurs in the early stage of chemotherapy,mainly caused by asparaginase.In imaging examination,the sensitivity of pancreatic magnetic resonance imaging is the highest,followed by abdominal ultrasound.Risk stratification,decreased albumin and elevated triglyceride are risk factors of ALL complicated with AP,which are helpful for early identification of high-risk patients with ALL complicated with AP.PCT and serum calcium may play an important role in severe pancreatitis.