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血清白蛋白减低对急性淋巴细胞白血病患儿感染的影响及预后分析
Analysis of the Impact of Serum Albumin Level on the Infections and Prognosis in Childhood Acute Lymphoblastic Leukemia
【摘要】 目的 本研究旨在探讨急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患儿初次诱导治疗期血清白蛋白(albumin,ALB)减低对发生严重感染及预后的影响。方法 回顾分析自2018年1月—2021年10月于安徽省儿童医院初诊并接受治疗的202例ALL患儿,收集其基线资料,化疗过程中体质指标及ALB变化和感染发生情况,总体生存(overall survival,OS)情况等。采用SPSS26.0软件进行相关因素分析,P<0.05为有统计学意义。结果 202例患儿发生严重感染51例(25.24%),多因素分析显示诱导化疗第15天血清ALB降低及初诊时外周血白细胞(white blood cell,WBC)≥50×10~9/L是发生严重感染的独立危险因素(P<0.05),第15天血清ALB水平及多因素联合作用预测发生严重感染效能高,死亡病例中大多数(55.55%)死于初次诱导缓解期严重感染,诱导化疗第33天白血病微小残留病(minimal residual disease,MRD)未转阴是影响OS的独立危险因素(P<0.05)。结论 儿童ALL在初次诱导缓解期易发生严重感染,化疗第15天ALB水平是严重感染的危险因素及预测因素,严重感染是早期化疗相关死亡的重要原因,诱导治疗33天MRD未转阴是影响OS的独立危险因素。在临床实践中应加强支持尤其是ALB供给,以提高疗效。
【Abstract】 Objective This study aims to investigate the impact of albumin level on the incidence of severe infections and the long prognosis in childhood acute lymphoblastic leukemia (ALL).Method A retrospective analysis was conducted on 202 ALL patients diagnosed and treated at the Anhui Provincial Children’s Hospital from January 2018 to October 2021.Baseline data,changes in body composition and albumin levels during chemotherapy,the occurrence of infections,and overall survival (OS) were collected.SPSS 26.0 software was used for the analysis of the related factors,with P<0.05 considered statistically significant.Results Out of the 202 children,51 cases (25.24%) developed severe infections.Multivariate analysis indicated that the albumin level on the 15th day (D15) and WBC ≥50×10~9/L at the time of diagnosis were independent risk factor for severe infection (P<0.05).Albumin levels on D15,in combination with other factors,predicted a high probability of developing severe infections,55.55% of the death cases died of severe infection in the first induction period,failure to achieve negative results for minimal residual disease (MRD) on day 33 were independent risk factors affecting the overall survival(P<0.05).Conclusion Children with acute lymphoblastic leukemia are susceptible to severe infections during the initial induction period,and the decrease of albumin on day 15 is a risk and predictive factor for severe infections,which is an important cause of early chemotherapy-related death.and the MRD on day33 remain positive affecting the OS.Clinical practice should focus on enhanced support,particularly albumin supplementation,to achieve better treatment outcomes.
【Key words】 Acute Lymphoblastic Leukemia; Pediatric patient; Severe Infections; Albumin; Overall Survival Rate;
- 【文献出处】 临床输血与检验 ,Journal of Clinical Transfusion and Laboratory Medicine , 编辑部邮箱 ,2024年03期
- 【分类号】R733.71
- 【下载频次】24