31例急性淋巴细胞白血病患儿使用培门冬酶并发急性胰腺炎的临床特点

Clinical Characteristics of 31 Children with Acute Lymphoblastic Leukemia Accompanied with Acute Pancreatitis Treated with Polyethylene Glycol Conjugated Asparaginase

目的探讨急性淋巴细胞白血病(ALL)患儿使用含培门冬酶化疗方案后并发急性胰腺炎的临床特点。方法收集2016年1月—2021年10月使用含培门冬酶化疗方案并发急性胰腺炎的ALL患儿31例。分析患儿年龄、性别、化疗方案、危险度分级、免疫分型、所处治疗阶段及培门冬酶累积使用量与急性胰腺炎病情轻重的相关性,探讨患儿的临床治疗及转归情况。结果31例患儿中,男21例(67.74%),女10例(32.26%),年龄范围3个月~14岁3个月。急性B淋巴细胞白血病27例,急性T淋巴细胞白血病4例。重症急性胰腺炎15例,与轻症急性胰腺炎比较,性别比例、年龄分布、化疗方案、危险度分级、免疫分型、所处治疗阶段和培门冬酶累积使用量均差异无统计学意义(均P>0.05)。结论儿童ALL使用含培门冬酶化疗方案后并发急性胰腺炎多在诱导缓解期出现。胰腺炎病情轻重与性别、年龄、化疗方案、危险度分级、免疫分型及培门冬酶累积使用量均无明显相关性。密切监测胰酶及影像学检查有助于及早发现和评估急性胰腺炎病情,指导后期用药。

Objective To investigate the occurrence and clinical characteristics of acute lymphoblastic leukemia(ALL)accompanied with acute pancreatitis(AP)after treatment with polyethylene glycol conjugated asparaginase(PEG-ASP)in children.Methods From January 2016 to October 2021,31 children with ALL accompanied with AP and treated with chemotherapy regimens containing PEG-ASP were collected.The age,gender,chemotherapy regimen,risk stratification,immune type,treatment stage,and cumulative PEG-ASP dosage of the children were collated to analyze their correlation with AP severity.The clinical treatments and outcomes of these children were also described and analyzed.Results The 31 children consisted of 21 males(67.74%)and 10 females(32.26%),with an age range of 3 months to 14 years and 3 months.There were 27 cases of acute B lymphoblastic leukemia and 4 cases of acute T lymphoblastic leukemia.In 15 cases of severe AP,these children had no significant differences in gender,age,chemotherapy regimen,risk stratification,immune type,treatment stage and cumulative PEG-ASP dosage when compared to mild AP(P>0.05).Conclusion Childhood leukemia accompanied with AP usually appears in the remission induction therapy.There are no significant correlations between severity of pancreatitis and gender,age,chemotherapy regimen,risk stratification,immune type,treatment stage and cumulative PEG-ASP dosage.Close monitoring of pancreatic enzymes and imaging changes is helpful for early detection and evaluation of AP,and for guiding the subsequent medical treatment.