肿瘤患儿化疗后感染情况分析
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摘要
目的探讨肿瘤患儿化疗后感染早期表现与感染严重程度的相关性。方法回顾性分析2014年1月-2017年12月在首都医科大学附属北京同仁医院儿科行化疗治疗并发生感染的88例肿瘤患儿临床病例资料,比较轻度感染和重度感染患儿早期临床表现差异。结果 88例肿瘤患儿以神经母细胞瘤和肝母细胞瘤为主,分别为25例占28.4%和20例占22.7%;88例感染患儿共感染223例次,轻度感染138例次、重度感染85例次;其中146例次神经母细胞瘤患儿中重度感染者45例次,57例次肝母细胞瘤患儿中重度感染者26例次,比较差异有统计学意义(χ~2=3.944,P=0.047);重度感染组患儿中在发热24h内出现寒战、畏寒、末梢循环不良和精神欠佳等临床症状,占比高于轻度感染组,两组比较差异均有统计学意义(P<0.05);所有化疗后感染患儿中重度感染患儿在发热初期中性粒细胞缺乏、热峰≥39.5℃和发热12h、CRP≥40mg/L患儿占比高于轻度感染患儿,两组比较差异均有统计学意义(P<0.05)。结论接受化疗期间感染早期伴有精神欠佳、寒战、畏寒、末梢循环不良、CRP≥40mg/L、WBC计数≤0.5×109/L和热峰≥39.5℃的患儿较易出现重度感染。
OBJECTIVE To explore the correlation between manifestations of infection in early stage after chemotherapy and severity of infection in children with cancer.METHODS The clinical data of 88 children with cancer who received chemotherapy in pediatrics department of Beijing Tongren Hospital,Capital Medical University from Jan 2014 to Dec 2017 and were complicated with infection were retrospectively analyzed.The clinical manifestations in early stage were observed and compared between the children with mild infection and the children with severe infection.RESULTS Of the 88 children with cancer,25(28.4%)had neuroblastoma,and 20(22.7%)had hepatoblastoma.Among the 88 children,totally 223 case-times of children had infection,including 138 case-times of mild infection and 85 case-times of severe infection.Totally 45 case-times of children had severe infection among 146 case-times of children with neuroblastoma,26 case-times of children had severe infection among 57 case-times of children with hepatoblastoma,and there was significant difference(χ~2=3.944,P=0.047).The children with severe infection had clinical symptoms such as shivering,chills,poor peripheral circulation and poor spirit within 24 hours of fever,the proportion of the children with severe infection who had the above clinical symptoms was higher than that of the children with mild infection,and there was significant difference between the two groups(P<0.05).The proportion of the children with severe infection who had neutropenia in initial stage of fever,thermal spike no less than 9.5℃,CRP level no less than 40 mg/L and fever for 12 hours was higher than that of the children with mild infection,and there was significant difference between the two groups(P<0.05).CONCLUSION The children who receive chemotherapy are complicated with poor spirit,shivering,chills and poor peripheral circulation in early stage of infection,and the children with the CRP level no less than 40 mg/L,WBC counts no more than 0.5×109/L and thermal spike no less than 39.5 ℃ tend to have severe infection.
OBJECTIVE To explore the correlation between manifestations of infection in early stage after chemotherapy and severity of infection in children with cancer.METHODS The clinical data of 88 children with cancer who received chemotherapy in pediatrics department of Beijing Tongren Hospital,Capital Medical University from Jan 2014 to Dec 2017 and were complicated with infection were retrospectively analyzed.The clinical manifestations in early stage were observed and compared between the children with mild infection and the children with severe infection.RESULTS Of the 88 children with cancer,25(28.4%)had neuroblastoma,and 20(22.7%)had hepatoblastoma.Among the 88 children,totally 223 case-times of children had infection,including 138 case-times of mild infection and 85 case-times of severe infection.Totally 45 case-times of children had severe infection among 146 case-times of children with neuroblastoma,26 case-times of children had severe infection among 57 case-times of children with hepatoblastoma,and there was significant difference(χ~2=3.944,P=0.047).The children with severe infection had clinical symptoms such as shivering,chills,poor peripheral circulation and poor spirit within 24 hours of fever,the proportion of the children with severe infection who had the above clinical symptoms was higher than that of the children with mild infection,and there was significant difference between the two groups(P<0.05).The proportion of the children with severe infection who had neutropenia in initial stage of fever,thermal spike no less than 9.5℃,CRP level no less than 40 mg/L and fever for 12 hours was higher than that of the children with mild infection,and there was significant difference between the two groups(P<0.05).CONCLUSION The children who receive chemotherapy are complicated with poor spirit,shivering,chills and poor peripheral circulation in early stage of infection,and the children with the CRP level no less than 40 mg/L,WBC counts no more than 0.5×109/L and thermal spike no less than 39.5 ℃ tend to have severe infection.
引文
[1]陈森敏,刘四喜,麦惠容,等.儿童恶性肿瘤化疗后医院感染特征及危险因素分析[J].中国感染与化疗杂志,2018,18(5):454-460.
[2]陈可可,邹润英,朱呈光.CRP、IL-6、IL-10在儿童血液病化疗后感染中的变化[J].医学临床研究,2016,33(4):799-800.
[3]Andronova VL.Modern ethiotropic chemotherapy of human cytomegalovirus infection:clinical effectiveness,molecular mechanism of action,drug resistance,new trends and prospects.Part 1[J].Vopr Virusol,2018,63(5):202-211.
[4]Andronova VL.Modern ethiotropic chemotherapy of human cytomegalovirus infection:clinical effectiveness,molecular mechanism of action,drug resistance,new trends and prospects.Part 2[J].Vopr Virusol,2018,63(6):250-260.
[5]Gong BF,Lin D,Wei H,et al.Primary prophylatic effect of voriconazole against invasive infection of pulmonary aspergillosis during remission-induction chemotherapy for acute myeloid leukemia[J].Zhongguo Shi Yan Xue Ye Xue Za Zhi,2018,26(5):1269-1274.
[6]Talima S,Kassem H,Kassem N.Chemotherapy and targeted therapy for breast cancer patients with hepatitis C virus infection[J].Breast Cancer,2019,26(2):154-163.
[7]Che E,Patel H.Comment on:treatment of infections caused by multidrug-resistant gram-negative bacteria:report of the British Society for Antimicrobial Chemotherapy/Healthcare Infection Society/British Infection Association Joint Working Party[J].J Antimicrob Chemother,2019,74(2):538.
[8]方晓,郑美珍,姜香琴,等.化疗期弥漫性大B细胞淋巴瘤患者皮肤损伤感染干预措施的研究[J].中华医院感染学杂志,2016,26(3):605-607.
[9]郎香花,黄健,章敏,等.急性白血病化疗患者血流感染的医源性危险因素分析[J].中华医院感染学杂志,2015,25(20):4696-4698.
[10]代艳,黄欣秋,何爽,等.急性淋巴细胞白血病患儿诱导化疗期感染的临床分析[J].中华医院感染学杂志,2016,26(8):1887-1889.
[11]梁利杰,梁华杰,孙慧.急性白血病患者化疗后感染的临床分析[J].中华医院感染学杂志,2014,24(15):3744-3746.
[12]杨祺,李朝霞,徐婷.肿瘤患儿化疗后细菌感染的临床分析[J].中华医院感染学杂志,2014,24(17):4359-4360,4365.
[13]白峰岩,房佰俊,王刚,等.急性白血病患儿化疗期间骨髓抑制合并感染检测降钙素原的临床意义[J].中华医院感染学杂志,2016,26(12):2840-2842.
[14]Hirashima T,Nagai T,Shigeoka H,et al.Comparison of the clinical courses and chemotherapy outcomes in metastatic colorectal cancer patients with and without active Mycobacteriumtuberculosisor Mycobacterium kansasii infection:a retrospective study[J].BMC Cancer,2014,14:770.
[15]Choi IK,Sung HJ,Lee JH,et al.The relationship between Helicobacter pylori infection and the effects of chemotherapy in patients with advanced or metastatic gastric cancer[J].Cancer Chemother Pharmacol,2012,70(4):555-558.
[16]杨希,陈丽萍,焦蓉,等.黄芪注射液对急性淋巴细胞白血病患儿诱导缓解化疗期间感染的影响[J].实用临床医药杂志,2017,21(3):105-108.
[17]Ching LC.Cochrane review summary for cancer nursing:lowbacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia[J].Cancer Nurs,2013,36(6):493.
[18]吴惠强,杜为强.降钙素原与C-反应蛋白测定在白血病患儿化疗后感染中的诊疗临床价值[J].中国临床医生杂志,2015,43(8):48-50.
[19]郝腾,李斯慧,李兴军,等.伴骨转移神经母细胞瘤患儿的临床特征、治疗效果及预后[J].中华实用儿科临床杂志,2017,32(3):182-186.
[20]虞飞燕.头孢吡肟治疗急性白血病化疗后感染的临床疗效观察[J].中国基层医药,2016,23(12):1884-1887.
[21]Berretta M,Caraglia M,Martellotta F,et al.Drug-drug interactions based on pharmacogenetic profile between highly active antiretroviral therapy and antiblastic chemotherapy in cancer patients with HIV infection[J].Front Pharmacol,2016,7:71.
[22]Sano H,Kobayashi R,Suzuki D,et al.Impact of the D-index deduced from duration and intensity of neutropenia following chemotherapy on the risk of invasive fungal infection in pediatric acute myeloid leukemia[J].Int J Hematol,2018,108(1):85-90.
[23]Bansal AK,Vishnubhatla S,Bakhshi S.Correlation of serum immunoglobulins with infection-related parameters during induction chemotherapy of pediatric acute myeloid leukemia:a prospective study[J].Pediatr Hematol Oncol,2015,32(2):129-137.
[2]陈可可,邹润英,朱呈光.CRP、IL-6、IL-10在儿童血液病化疗后感染中的变化[J].医学临床研究,2016,33(4):799-800.
[3]Andronova VL.Modern ethiotropic chemotherapy of human cytomegalovirus infection:clinical effectiveness,molecular mechanism of action,drug resistance,new trends and prospects.Part 1[J].Vopr Virusol,2018,63(5):202-211.
[4]Andronova VL.Modern ethiotropic chemotherapy of human cytomegalovirus infection:clinical effectiveness,molecular mechanism of action,drug resistance,new trends and prospects.Part 2[J].Vopr Virusol,2018,63(6):250-260.
[5]Gong BF,Lin D,Wei H,et al.Primary prophylatic effect of voriconazole against invasive infection of pulmonary aspergillosis during remission-induction chemotherapy for acute myeloid leukemia[J].Zhongguo Shi Yan Xue Ye Xue Za Zhi,2018,26(5):1269-1274.
[6]Talima S,Kassem H,Kassem N.Chemotherapy and targeted therapy for breast cancer patients with hepatitis C virus infection[J].Breast Cancer,2019,26(2):154-163.
[7]Che E,Patel H.Comment on:treatment of infections caused by multidrug-resistant gram-negative bacteria:report of the British Society for Antimicrobial Chemotherapy/Healthcare Infection Society/British Infection Association Joint Working Party[J].J Antimicrob Chemother,2019,74(2):538.
[8]方晓,郑美珍,姜香琴,等.化疗期弥漫性大B细胞淋巴瘤患者皮肤损伤感染干预措施的研究[J].中华医院感染学杂志,2016,26(3):605-607.
[9]郎香花,黄健,章敏,等.急性白血病化疗患者血流感染的医源性危险因素分析[J].中华医院感染学杂志,2015,25(20):4696-4698.
[10]代艳,黄欣秋,何爽,等.急性淋巴细胞白血病患儿诱导化疗期感染的临床分析[J].中华医院感染学杂志,2016,26(8):1887-1889.
[11]梁利杰,梁华杰,孙慧.急性白血病患者化疗后感染的临床分析[J].中华医院感染学杂志,2014,24(15):3744-3746.
[12]杨祺,李朝霞,徐婷.肿瘤患儿化疗后细菌感染的临床分析[J].中华医院感染学杂志,2014,24(17):4359-4360,4365.
[13]白峰岩,房佰俊,王刚,等.急性白血病患儿化疗期间骨髓抑制合并感染检测降钙素原的临床意义[J].中华医院感染学杂志,2016,26(12):2840-2842.
[14]Hirashima T,Nagai T,Shigeoka H,et al.Comparison of the clinical courses and chemotherapy outcomes in metastatic colorectal cancer patients with and without active Mycobacteriumtuberculosisor Mycobacterium kansasii infection:a retrospective study[J].BMC Cancer,2014,14:770.
[15]Choi IK,Sung HJ,Lee JH,et al.The relationship between Helicobacter pylori infection and the effects of chemotherapy in patients with advanced or metastatic gastric cancer[J].Cancer Chemother Pharmacol,2012,70(4):555-558.
[16]杨希,陈丽萍,焦蓉,等.黄芪注射液对急性淋巴细胞白血病患儿诱导缓解化疗期间感染的影响[J].实用临床医药杂志,2017,21(3):105-108.
[17]Ching LC.Cochrane review summary for cancer nursing:lowbacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia[J].Cancer Nurs,2013,36(6):493.
[18]吴惠强,杜为强.降钙素原与C-反应蛋白测定在白血病患儿化疗后感染中的诊疗临床价值[J].中国临床医生杂志,2015,43(8):48-50.
[19]郝腾,李斯慧,李兴军,等.伴骨转移神经母细胞瘤患儿的临床特征、治疗效果及预后[J].中华实用儿科临床杂志,2017,32(3):182-186.
[20]虞飞燕.头孢吡肟治疗急性白血病化疗后感染的临床疗效观察[J].中国基层医药,2016,23(12):1884-1887.
[21]Berretta M,Caraglia M,Martellotta F,et al.Drug-drug interactions based on pharmacogenetic profile between highly active antiretroviral therapy and antiblastic chemotherapy in cancer patients with HIV infection[J].Front Pharmacol,2016,7:71.
[22]Sano H,Kobayashi R,Suzuki D,et al.Impact of the D-index deduced from duration and intensity of neutropenia following chemotherapy on the risk of invasive fungal infection in pediatric acute myeloid leukemia[J].Int J Hematol,2018,108(1):85-90.
[23]Bansal AK,Vishnubhatla S,Bakhshi S.Correlation of serum immunoglobulins with infection-related parameters during induction chemotherapy of pediatric acute myeloid leukemia:a prospective study[J].Pediatr Hematol Oncol,2015,32(2):129-137.