【作者】 林源；

【导师】 单庆文；

【作者基本信息】 广西医科大学 ， 儿科学（专业学位）， 2025， 硕士

【摘要】 目的和意义:探讨7岁以下急性淋巴细胞白血病(Acute Lymphoblastic Leukemia,ALL)患儿初诊时营养状况与医院内感染、住院时长、住院费用及早期疗效等相关因素的关系,提高临床对住院急性淋巴细胞白血病患儿营养状态的认识和重视程度。方法:回顾性分析2023年10月至2024年10月广西医科大学第一附属医院收治的123例7岁以下ALL患儿的临床资料,根据初诊时营养状况分为营养失衡组和营养正常组,采用χ~2检验(或Fisher确切概率法)、t检验或非参数检验,比较两组在医院内感染、住院时长、住院费用、实验室指标、第33天骨髓微小残留病(Minimal Residual Disease,MRD)阴性率、化疗相关不良反应等方面的差异。结果:1、共纳入ALL患儿123例,中位数年龄为42月(13月～81月)。男性79例(64.2%),女性44例(35.8%),男女比例约1.8:1。免疫分型为B-ALL112例(91.1%),T-ALL11例(8.9%),比例约为10.2:1。初诊时营养失衡24例(19.5%),营养正常99例(80.5%)。2、营养失衡组医院内感染发生率(58.3%)显著高于营养正常组(36.4%)(P<0.05),营养失衡组患儿肝功能损伤发生率显著高于营养正常组(P<0.05),且营养失衡组血清碱性磷酸酶(Alkaline Phosphatase,ALP)水平较低(P<0.05)。3、存在医院内感染者住院时长、初次住院费用高于无医院内感染者(P<0.05)。4、第33天MRD阴性组的医院内感染发生率、住院时长和住院费用均显著低于MRD阳性组(P<0.05)。B-ALL患儿的第33天MRD阴性率显著高于T-ALL(P<0.05)。结论:1、初诊时营养失衡(营养不良或营养过剩)可能是发生医院内感染的危险因素。2、营养不良或营养过剩可能与化疗相关的肝功能损伤、ALP低水平有关。3、免疫分型和医院内感染是影响早期疗效的危险因素,在诱导缓解阶段发生医院内感染可能延长治疗周期、增加经济负担,甚至影响早期疗效。更多还原

【Abstract】 Objective To investigate the relationship between nutritional status at diagnosis and nosocomial infections,length of stay,hospitalization costs,and early treatment response in children under 7 years old with acute lymphoblastic leukemia(ALL).This study aims to enhance clinical awareness and attention to the nutritional status of hospitalized ALL patients.Method A retrospective analysis was conducted on the clinical data of123 children under the age of 7 with ALL who were admitted to the First Affiliated Hospital of Guangxi Medical University from October 2023 to October 2024.Based on their nutritional status at initial diagnosis,the patients were divided into a nutritional imbalance group and a normal nutrition group.Differences between the two groups in terms of nosocomial infections,length of hospital stay,hospitalization costs,laboratory indicators,the negative rate of Minimal Residual Disease(MRD)in bone marrow on day 33 and chemotherapy-related adverse reactions were compared usingχ~2test(or Fisher’s exact test),t-test,or non-parametric tests.Result1.A total of 123 pediatric patients with ALL were enrolled,with a median age of 42 months(range:13 to 81 months).There were 79 males(64.2%)and 44females(35.8%),with a male-to-female ratio of approximately 1.8:1.Immunophenotyping revealed 112 cases of B-ALL(91.1%)and 11 cases of T-ALL(8.9%),with a ratio of approximately 10.2:1.At initial diagnosis,24patients(19.5%)exhibited nutritional imbalance,while 99 patients(80.5%)were nutritionally normal.2.The incidence of nosocomial infections in the nutritional imbalance group(58.3%)was significantly higher than that in the nutritionally normal group(36.4%)(P<0.05).The prevalence of hepatotoxicity was higher than that in the nutritionally normal group(P<0.05).Additionally,the nutritional imbalance group had lower serum alkaline phosphatase(ALP)levels(P<0.05).3.The length of hospital stay and initial hospitalization costs were significantly higher in patients with nosocomial infections compared to those without(P<0.05).4.The incidence of nosocomial infections,length of hospital stay,and hospitalization costs were significantly lower in the MRD-negative group at day33 compared to the MRD-positive group(P<0.05).The MRD-negative rate at day 33 was significantly higher in B-ALL patients than in T-ALL patients(P<0.05).Conclusion1.At the initial diagnosis,nutritional imbalance,whether presenting as malnutrition or overnutrition may be a risk factor for the development of nosocomial infections.2.Both malnutrition and overnutrition may be associated with chemotherapy-associated hepatotoxicity and low ALP levels.3.Immunophenotyping and nosocomial infections are critical risk factors that can influence early treatment efficacy.The onset of nosocomial infections during the induction remission phase may prolong the treatment duration,increase financial burden,and potentially compromise early therapeutic outcomes.更多还原