評(píng)價(jià)CCLG-08方案治療339例兒童急性淋巴細(xì)胞白血病誘導(dǎo)期感染并發(fā)癥
發(fā)布時(shí)間：2019-03-11 08:24
【摘要】：目的初步評(píng)價(jià)CCLG-2008誘導(dǎo)治療方案并發(fā)癥,主要了解整體感染及各組間感染；常見的感染部位、感染病原體分布；感染時(shí)機(jī)和高危因素；真菌感染率。方法分析我院2008年至2011年339例初治兒童急性淋巴細(xì)胞白血病(ALL)在誘導(dǎo)治療過程中的感染情況,評(píng)價(jià)標(biāo)、中、高危組間感染差異。同時(shí),回顧性分析我院2002年至2005年79例初治兒童急性淋巴細(xì)胞白血病在誘導(dǎo)治療過程中(采用CAMS-ALL-2002方案),糖皮質(zhì)激素采用潑尼松時(shí)的感染情況。結(jié)果1、CCLG-2008方案中共有303例患兒進(jìn)行誘導(dǎo)治療,標(biāo)危組151例,中危組81例,高危組71例。其中,195例患兒誘導(dǎo)期間出現(xiàn)感染,整體感染率為64.36%(195／303),三組感染率分別為64.9%,64.19%,63.38%,無統(tǒng)計(jì)學(xué)差異(P=0.996)。感染死亡率3.63%(11／303)。110例患兒有明確的感染部位(110／195,56.41%),按頻率高低依次為呼吸道、血液、口腔、消化道、皮膚和軟組織,發(fā)生率分別為82.72%、30%、11.82%、6.32%、2.72%�？拐婢幬锸褂寐蕿�37.43%(73／195)。明確病原的感染為412例次(42／110,38.18%),G-敗血癥29例次(29／41,70.73%),G+敗血癥12例次(12／41,29.27%)；1例為真菌敗血癥。常見細(xì)菌種類依次為肺炎克雷伯菌、大腸埃希菌、銅綠假單胞菌。單聯(lián)抗生素控制感染患兒為150例(150／195,76.92%),兩聯(lián)抗生素控制感染患兒為45例(45／195,23.08%)2、CAMS-ALL-2002方案中共有79例進(jìn)行誘導(dǎo)治療,整體感染率為55.70%(44／79,55.7%),感染死亡率2.53%(2／79)。18例患兒有明確的感染部位(18／44,40.91%),按頻率高低依次為上呼吸道(10／18,55.56%),下呼吸道(6／18,33.34%),血液(4／18,22.23%),口腔(4／18,22.23%),肛周(1／18,5.56%),顱腦(1／18,5.56%)。抗真菌藥物使用率為13.64%(6／44)。僅有4人有明確病原菌,分別為肺炎克雷伯菌、肺炎鏈球菌、卡他布蘭漢氏菌、人葡萄球菌。單聯(lián)抗生素控制感染患兒為38例(38／44,86.36%),兩聯(lián)抗生素控制感染患兒為6例(6／44,13.64%)結(jié)論CCLG-08方案,各組間感染率無統(tǒng)計(jì)學(xué)差異(P=0.996)；感染部位以呼吸道為主；病原菌分布以G-為主；感染多發(fā)生在誘導(dǎo)治療中期；低齡患兒,粒缺期及粒缺期持續(xù)時(shí)間是感染高危因素,感染無性別差異。地塞米松沒有明顯增加感染的風(fēng)險(xiǎn)。
[Abstract]:Objective to evaluate the complications of CCLG-2008 induction therapy, mainly to understand the overall infection and infection among groups, common infection sites, distribution of infection pathogens, infection timing and high risk factors, fungal infection rate. Methods the infection of (ALL) in 339 children with acute lymphoblastic leukemia from 2008 to 2011 was analyzed, and the difference of infection between middle and high risk groups was evaluated. At the same time, 79 cases of childhood acute lymphoblastic leukemia in our hospital from 2002 to 2005 were analyzed retrospectively in the course of induction therapy (using CAMS-ALL-2002 regimen), and the infection of glucocorticoid with prednisone was analyzed retrospectively. Results 1. There were 303 children received induction therapy in CCLG 2008 program, 151 children in the standard risk group, 81 patients in the middle risk group and 71 patients in the high risk group. The infection rate was 64.36% (195 / 303) in the whole group, 64.9%, 64.19% and 63.38% in the three groups, respectively. There was no significant difference between the three groups (P = 0.996). The mortality rate of infection was 3.63% (11 / 303). 110 children had a definite infection site (110 脳 195, 56.41%), and the incidence rates were 82.72% in respiratory tract, blood, oral cavity, digestive tract, skin and soft tissue, in order of frequency. 30 percent, 11.82 percent, 6.32 percent, 2.72 percent. The utilization rate of antifungal drugs was 37.43% (73 / 195). The pathogen infection was identified in 412 cases (42 脳 110, 38.18%), G-septicemia in 29 cases (29 / 41, 70.73%) in 12 cases (12 / 41, 29.27%), and one case was fungal septicemia. The common bacteria were Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa. There were 150 cases (150,76.92%) of single antibiotic controlled infection, 45 cases (45,23.08%) 2 cases of single antibiotic controlled infection, 79 cases of them were treated by induction therapy in CAMSM / ALL2002 regimen, the results showed that the two antibiotics could be used to control the infection in 45 cases (45%, 23.08%) 2. The overall infection rate was 55.70% (44 / 79, 55.7%) and the mortality rate was 2.53% (2 / 79). 18 children had a definite infection site (18 / 44, 40.91%) and the upper respiratory tract (10 / 18, 55.56%) in order of frequency. Lower respiratory tract (6-18, 33.34%), blood (4-18, 22. 23%), oral (4-18, 22. 23%), perianal (1-18, 5. 56%), brain (1-18, 5. 56%). The utilization rate of antifungal drugs was 13.64% (6 / 44). Only 4 people have definite pathogenic bacteria, which are Klebsiella pneumoniae, Streptococcus pneumoniae, Branschanella katabransis and Staphylococcus hominis. 38 cases (38? 44, 86.36%) were controlled by single antibiotics, 6 cases (6? 44, 13.64%) were controlled by two antibiotics? conclusion there is no significant difference in infection rate among the three groups (P = 0.996). Conclusion CCLG-08 regimen has no significant difference among the three groups (P < 0.05). The infection site is mainly respiratory tract; the distribution of pathogenic bacteria is mainly G -; most of the infections occur in the middle stage of induction therapy; in young children, the grain deficiency period and the duration of grain deficiency period are the high risk factors of infection, and there is no gender difference in infection. Dexamethasone did not significantly increase the risk of infection.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R733.71
本文編號(hào)：2438125
[Abstract]:Objective to evaluate the complications of CCLG-2008 induction therapy, mainly to understand the overall infection and infection among groups, common infection sites, distribution of infection pathogens, infection timing and high risk factors, fungal infection rate. Methods the infection of (ALL) in 339 children with acute lymphoblastic leukemia from 2008 to 2011 was analyzed, and the difference of infection between middle and high risk groups was evaluated. At the same time, 79 cases of childhood acute lymphoblastic leukemia in our hospital from 2002 to 2005 were analyzed retrospectively in the course of induction therapy (using CAMS-ALL-2002 regimen), and the infection of glucocorticoid with prednisone was analyzed retrospectively. Results 1. There were 303 children received induction therapy in CCLG 2008 program, 151 children in the standard risk group, 81 patients in the middle risk group and 71 patients in the high risk group. The infection rate was 64.36% (195 / 303) in the whole group, 64.9%, 64.19% and 63.38% in the three groups, respectively. There was no significant difference between the three groups (P = 0.996). The mortality rate of infection was 3.63% (11 / 303). 110 children had a definite infection site (110 脳 195, 56.41%), and the incidence rates were 82.72% in respiratory tract, blood, oral cavity, digestive tract, skin and soft tissue, in order of frequency. 30 percent, 11.82 percent, 6.32 percent, 2.72 percent. The utilization rate of antifungal drugs was 37.43% (73 / 195). The pathogen infection was identified in 412 cases (42 脳 110, 38.18%), G-septicemia in 29 cases (29 / 41, 70.73%) in 12 cases (12 / 41, 29.27%), and one case was fungal septicemia. The common bacteria were Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa. There were 150 cases (150,76.92%) of single antibiotic controlled infection, 45 cases (45,23.08%) 2 cases of single antibiotic controlled infection, 79 cases of them were treated by induction therapy in CAMSM / ALL2002 regimen, the results showed that the two antibiotics could be used to control the infection in 45 cases (45%, 23.08%) 2. The overall infection rate was 55.70% (44 / 79, 55.7%) and the mortality rate was 2.53% (2 / 79). 18 children had a definite infection site (18 / 44, 40.91%) and the upper respiratory tract (10 / 18, 55.56%) in order of frequency. Lower respiratory tract (6-18, 33.34%), blood (4-18, 22. 23%), oral (4-18, 22. 23%), perianal (1-18, 5. 56%), brain (1-18, 5. 56%). The utilization rate of antifungal drugs was 13.64% (6 / 44). Only 4 people have definite pathogenic bacteria, which are Klebsiella pneumoniae, Streptococcus pneumoniae, Branschanella katabransis and Staphylococcus hominis. 38 cases (38? 44, 86.36%) were controlled by single antibiotics, 6 cases (6? 44, 13.64%) were controlled by two antibiotics? conclusion there is no significant difference in infection rate among the three groups (P = 0.996). Conclusion CCLG-08 regimen has no significant difference among the three groups (P < 0.05). The infection site is mainly respiratory tract; the distribution of pathogenic bacteria is mainly G -; most of the infections occur in the middle stage of induction therapy; in young children, the grain deficiency period and the duration of grain deficiency period are the high risk factors of infection, and there is no gender difference in infection. Dexamethasone did not significantly increase the risk of infection.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R733.71
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