文章摘要
杨 凯,方拥军,孙晓燕,戎留成,张 永.儿童急性淋巴细胞白血病中枢复发的临床分析[J].南京医科大学学报,2021,(4):564~568
儿童急性淋巴细胞白血病中枢复发的临床分析
Clinical analysis of children with CNS relapsed acute lymphoblastic leukemia
投稿时间:2020-03-19  
DOI:10.7655/NYDXBNS20210415
中文关键词: 急性淋巴细胞白血病  中枢神经系统  复发  危险因素
英文关键词: acute lymphoblastic leukemia  central nervous system  relapse  risk factor
基金项目:国家自然科学基金(81670155,81602913);江苏省妇幼重点学科(FXK201742)
作者单位
杨 凯 南京医科大学附属儿童医院血液肿瘤科江苏 南京 210008 
方拥军 南京医科大学附属儿童医院血液肿瘤科江苏 南京 210008 
孙晓燕 南京医科大学附属儿童医院血液肿瘤科江苏 南京 210008 
戎留成 南京医科大学附属儿童医院血液肿瘤科江苏 南京 210008 
张 永 南京医科大学附属儿童医院药学部江苏 南京 210008 
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中文摘要:
      目的:探讨儿童急性淋巴细胞白血病(acute lymphonblastic leukemia,ALL)中枢神经系统复发的危险因素。方法:回顾性分析2013年1月—2018年7月南京医科大学附属儿童医院治疗的426例ALL患儿临床资料。将研究对象按照不同的治疗方案和临床特征分组,比较中枢复发率,并分析中枢复发的危险因素及复发患儿的预后不良因素。结果:①CCCG?ALL?2015方案治疗的患儿中枢复发率低于儿童急性淋巴细胞白血病诊疗建议(2006方案)治疗的患儿(P < 0.01);②男性、白细胞计数≥50×109个/L、T细胞急性淋巴细胞白血病(T?cell acute lymphoblastic leukemia,T?ALL)患儿中枢复发率明显较高(P < 0.05);③Logistic多因素回归分析提示白细胞计数≥50×109个/L和T?ALL是中枢复发的独立危险因素(P < 0.05);④Kaplan?Meier生存分析发现激素诱导后外周血幼稚细胞计数≥1×109个/L、血小板计数≤20×109个/L的中枢复发患儿总生存率更低(P < 0.05)。结论:2015方案较2006方案有效减少了中枢复发;2015方案与2006方案的危险因素相同,存在中枢复发高危因素的病例应加强中枢复发的预防。
英文摘要:
      Objective:To explore the risk factors of the central nervous system recurrence in children with acute lymphoblastic leukemia. Methods:Retrospectively analyzed clinical data of 426 children with ALL treated in our hospital from January 2013 to July 2018. The subjects were divided into two groups according to different treatment plan and clinical characteristics to compare the recurrence rate of the central nervous system,and to analyze the risk factors of central recurrence and the poor prognostic factors of children with recurrence. Results:①The central recurrence rate of Children treated with CCCG?ALL?2015 scheme(scheme 2015)was lower than that of children treated with diagnosis and treatment of childhood acute lymphoblastic leukemia(scheme 2006)(P < 0.01);②The central recurrence rate of children with male,leukocyte count≥50×109/L and T?ALL was significantly higher(P < 0.05);③Logistic regression analysis suggested that leukocyte count≥50×109/L and T?ALL were independent risk factors of central recurrence(P < 0.05);④K?M survival analysis showed that the overall survival rate of children with hormone induced peripheral blood immature cell count≥1×109/L and platelet count≤20×109/L was lower(P < 0.05). Conclusion:Scheme 2015 effectively reduced central recurrence compared with scheme 2006. The risk factors of the 2015 regimen were the same as those of the 2006 regimen,and the prevention of central recurrence should be strengthened in the cases with central recurrence risk factors.
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