评价CCLG-08方案治疗339例儿童急性淋巴细胞白血病诱导期感染并发症
发布时间：2019-03-11 08:24
【摘要】：目的初步评价CCLG-2008诱导治疗方案并发症,主要了解整体感染及各组间感染；常见的感染部位、感染病原体分布；感染时机和高危因素；真菌感染率。方法分析我院2008年至2011年339例初治儿童急性淋巴细胞白血病(ALL)在诱导治疗过程中的感染情况,评价标、中、高危组间感染差异。同时,回顾性分析我院2002年至2005年79例初治儿童急性淋巴细胞白血病在诱导治疗过程中(采用CAMS-ALL-2002方案),糖皮质激素采用泼尼松时的感染情况。结果1、CCLG-2008方案中共有303例患儿进行诱导治疗,标危组151例,中危组81例,高危组71例。其中,195例患儿诱导期间出现感染,整体感染率为64.36%(195／303),三组感染率分别为64.9%,64.19%,63.38%,无统计学差异(P=0.996)。感染死亡率3.63%(11／303)。110例患儿有明确的感染部位(110／195,56.41%),按频率高低依次为呼吸道、血液、口腔、消化道、皮肤和软组织,发生率分别为82.72%、30%、11.82%、6.32%、2.72%。抗真菌药物使用率为37.43%(73／195)。明确病原的感染为412例次(42／110,38.18%),G-败血症29例次(29／41,70.73%),G+败血症12例次(12／41,29.27%)；1例为真菌败血症。常见细菌种类依次为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌。单联抗生素控制感染患儿为150例(150／195,76.92%),两联抗生素控制感染患儿为45例(45／195,23.08%)2、CAMS-ALL-2002方案中共有79例进行诱导治疗,整体感染率为55.70%(44／79,55.7%),感染死亡率2.53%(2／79)。18例患儿有明确的感染部位(18／44,40.91%),按频率高低依次为上呼吸道(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%),颅脑(1／18,5.56%)。抗真菌药物使用率为13.64%(6／44)。仅有4人有明确病原菌,分别为肺炎克雷伯菌、肺炎链球菌、卡他布兰汉氏菌、人葡萄球菌。单联抗生素控制感染患儿为38例(38／44,86.36%),两联抗生素控制感染患儿为6例(6／44,13.64%)结论CCLG-08方案,各组间感染率无统计学差异(P=0.996)；感染部位以呼吸道为主；病原菌分布以G-为主；感染多发生在诱导治疗中期；低龄患儿,粒缺期及粒缺期持续时间是感染高危因素,感染无性别差异。地塞米松没有明显增加感染的风险。
[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.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R733.71
本文编号：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.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R733.71
【共引文献】
相关期刊论文 前2条
1 李海燕;徐志伟;陈益平;董琳;;儿童急性白血病合并水痘10例临床分析[J];中国当代儿科杂志;2012年06期
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相关硕士学位论文 前4条
1 吴丕六;儿童白血病发病危险因素相关性研究[D];重庆医科大学;2009年
2 仲春红;急性白血病医院感染相关因素分析[D];山东大学;2010年
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4 金广霞;778例急性白血病患者合并院内感染临床分析[D];安徽医科大学;2012年
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