急性淋巴细胞白血病患儿血小板输注疗效及影响因素分析

发布时间：2018-05-08 10:50

本文选题：急性淋巴细胞白血病 + 血小板输注　；参考：《中国循证儿科杂志》2017年01期

【摘要】：目的探讨急性淋巴细胞白血病(ALL)患儿血小板输注的疗效及其影响因素。方法纳入2013年1月1日至2016年6月30日在中南大学湘雅三医院血液科及儿科就诊的全部初诊、初治,且在治疗过程中至少输注1次单采血小板的、14岁的ALL患儿。单采血小板的输注采用ABO、Rh同型输注策略。每例每次输注血小板后同时满足24 h校正血小板增加指数(CCI)4.5和24 h血小板回收率(PPR)20%,且消化道、鼻和牙龈出血症状得到控制,判定为当次输注有效,否则为当次输注无效。有效例次归为有效组,无效例次归为无效组。对可能影响血小板输注疗效的因素(年龄、性别、发热、出血、脾大、感染、是否使用头孢菌素、血小板输注次数)行单因素和多因素分析。结果 44例ALL患儿进入本文分析,共输注单采血小板302例次,有效组197例次(65.2%),无效组105例次,每例患儿平均输注(6.1±5.6)次。302例次中;输注血小板前后的血小板计数(×10~9·L~(-1))分别为19.2±9.4和66.1±36.2,差异有统计学意义(t=11.19,P0.01);输注1次(44例次)、~5次(93例次)、~10次(67例次)和10次(98例次)的输注有效率分别为84.1%、76.3%、56.7%和52.0%。单因素分析显示,有效组和无效组比较,发热、出血、脾大、感染和血小板输注次数差异有统计学意义,P均0.05。Logistic多因素回归分析显示,发热(OR=3.737,95%CI:1.213~11.513)和感染(OR=3.258;95%CI:1.019~10.419)是影响血小板输注疗效的主要危险因素。结论血小板输注可以改善ALL患儿的血小板计数及出血症状,发热和感染为影响ALL患儿血小板输注疗效的主要危险因素。
[Abstract]:Objective to investigate the effect of platelet transfusion in children with acute lymphoblastic leukemia (ALL) and its influencing factors. Methods from January 1, 2013 to June 30, 2016, all the patients with ALL, aged 14 years, who were first diagnosed in the Department of Hematology and Pediatrics, Xiangya third Hospital, Central South University, and who received at least one transfusion of platelets during the course of treatment, were enrolled in the study. The single platelets were infused with the same type of ABO Rh infusion strategy. After each transfusion of platelets, 24 h adjusted platelet increase index (CCI) 4.5 and 24 h platelet recovery rate (PPR-20) were satisfied. The bleeding symptoms of digestive tract, nose and gingival were controlled, which was determined to be effective for the second infusion, otherwise it would not be effective for the current infusion. Valid cases are classified as valid group and invalid cases as invalid group. Univariate and multivariate analysis was performed on factors (age, sex, fever, bleeding, splenomegaly, infection, use of cephalosporins and platelet transfusion times) that might affect the efficacy of platelet transfusion. Results 44 cases of ALL were analyzed in this paper. A total of 302 cases of platelets were infused, 197 cases of effective group were treated with 65.2times, 105 cases of ineffective group were given, the average infusion time of each child was 6.1 卤5.6 times. The platelet count (脳 109L ~ (-1) before and after transfusion was 19.2 卤9.4 and 66.1 卤36.2, respectively. The difference was statistically significant (P < 0.01); the effective rate of infusion was 84.1L 76.3i% and 52.0%, respectively. The effective rate of transfusion was 84.1L 76.3AD 56.7% and 52.075%, respectively, and that of 44 cases (44 cases) was 95 times (67 cases) and 98 times (10 times). The effective rates of platelet count before and after transfusion were 84.1 卤9.4 and 66.1 卤36.2respectively, and the effective rates were 52.0% and 52.0%, respectively. Univariate analysis showed that there were significant differences in fever, hemorrhage, splenomegaly, infection and platelet transfusion between the effective group and the ineffective group by 0.05.Logistic multivariate regression analysis. The main risk factors affecting the efficacy of platelet transfusion were fever 3.737 / 95 CI: 1.213 (11.513) and infection (3.25895 CI: 1.019 10.419). Conclusion Platelet transfusion can improve platelet count and bleeding symptoms in children with ALL. Fever and infection are the main risk factors affecting the efficacy of platelet transfusion in ALL children.
【作者单位】：中南大学湘雅三医院输血科;
【分类号】：R457.1;R733.71

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