摘要
目的分析培门冬酰胺酶治疗急性淋巴细胞白血病(ALL)患儿的高血糖发生情况及危险因素,为改善ALL患儿长期预后及临床治疗提供参考意义。方法回顾性分析江西省儿童医院2016年1月至2021年6月收治的728例ALL患儿的临床资料,研究对象均进行培门冬酰胺酶治疗,所有研究对象诱导化疗期间至少每周复查1次血糖,根据诱导化疗后是否继发高血糖将其分为继发高血糖组(n=16)、非继发高血糖组(n=712)。采用单因素分析及多因素logistic回归分析筛选ALL患儿培门冬酰胺酶治疗过程中发生高血糖的独立危险因素。结果培门冬酰胺酶治疗ALL患儿时高血糖发生率为2.20%(16/728);单因素分析结果提示,不同免疫分型、白血病危险度分型、髓外侵犯情况以及初始乳酸脱氢酶(LDH)水平的ALL患儿诱导化疗期间的血糖水平比较,差异有统计学意义(P<0.05);多因素分析结果提示,中危型白血病(β=2.028,OR=7.599,95%CI:1.727~33.440)、合并骨髓侵犯(β=1.691,OR=5.425,95%CI:1.050~28.036)以及初始LDH水平≥高限2倍(β=1.496,OR=4.464,95%CI:1.446~13.777)均是影响ALL患儿继发高血糖的独立危险因素(P<0.05)。结论ALL患儿白血病免疫分型、白血病危险度分型为高危、合并髓外侵犯以及初始LDH水平≥高限2倍等均可独立导致ALL患儿诱导化疗后继发高血糖,医务人员需针对具备上述危险因素的患儿展开严密监测,并对已发生高血糖者及时采取降糖干预措施。
Objective To analyze the occurrence situation and risk factors of hyperglycemia in children with acute lymphoblastic leukemia(ALL)treated by Pegasparaginase,and to provide reference for improving the long-term prognosis and clinical treatment of children with ALL.Methods The clinical data of 728 children with ALL admitted to Jiangxi Provincial Children's Hospital from January 2016 to June 2021 were retrospectively analyzed.All subjects were treated with Pegasparaginase,and their blood glucose was reviewed at least once a week during induction chemotherapy.According to whether secondary hyperglycemia occurred after induction chemotherapy,the children were divided into the secondary hyperglycemia group(n=16)and the non-secondary hyperglycemia group(n=712).Univariate analysis and multivariate logistic regression analysis were used to screen out the independent risk factors of hyperglycemia in children with ALL during Pegasparaginase treatment.Results The incidence rate of hyperglycemia was 2.20%(16/728)in children with ALL treated by Pegasparaginase.Univariate analysis showed that there were statistically significant difference in blood glucose level during induction chemotherapy in ALL children with different immunophenotypes,leukemia risk types,extramedullary invasion and initial lactate dehydrogenase(LDH)levels(P<0.05).Multivariate analysis revealed that intermediate-risk leukemia(β=2.028,OR=7.599,95%CI:1.727-33.440),presence of bone marrow invasion(β=1.691,OR=5.425,95%CI:1.050-28.036)and initial LDH level≥2 times of the upper limit(β=1.496,OR=4.464,95%CI:1.446-13.777)were independent risk factors for secondary hyperglycemia in children with ALL(P<0.05).Conclusion The high-risk leukemia immunophenotyping,high-risk leukemia risk typing,extramedullary invasion and initial LDH level≥2 times of the upper limit in children with ALL can independently lead to secondary hyperglycemia in children with ALL after induction chemotherapy.It is necessary to closely monitor children with the above risk factors by medical
作者
陈庆法
刘福稳
梁昌达
CHEN Qingfa;LIU Fuwen;LIANG Changda(Department of Hematology,Jiangxi Provincial Children's Hospital,Jiangxi Province,Nanchang330000,China)
出处
《中国当代医药》
CAS
2023年第5期99-102,共4页
China Modern Medicine
基金
江西省卫生健康委科技计划项目(202130850)。
