Zorzi Alexandra P, Yang Connie L, Dell Sharon, Nathan Paul C
*Children's Hospital, Department of Pediatrics, Division of Hematology/Oncology, Western University, London Departments of ‡Pediatrics, Division of Respiratory Medicine §Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON †BC Children's Hospital, Department of Pediatrics, Division of Respirology, University of British Columbia, Vancouver, BC, Canada.
J Pediatr Hematol Oncol. 2015 Nov;37(8):e447-52. doi: 10.1097/MPH.0000000000000424.
Pulmonary disease is a significant morbidity among childhood cancer survivors. The aim of this study was to characterize the pulmonary dysfunction experienced by childhood cancer survivors treated with bleomycin. A cross-sectional analysis of pulmonary function testing (PFT) in survivors treated with bleomycin was preformed. The most recent posttherapy PFT was assessed. Spirometry and lung volumes were categorized as normal, restrictive, obstructive, or mixed. Diffusing capacity of carbon monoxide (DLCO) was categorized as normal or abnormal. PFT data of 143 survivors was analyzed. PFTs were performed a median of 2.3 years (interquartile range, 1.4 to 4.9) from completion of therapy. Spirometry was abnormal in 58 (41%), only 5 (9%) had respiratory symptoms. Forty-two (70%) had obstructive, 11 (18%) restrictive, and 5 (9%) mixed ventilatory defects. The majority of abnormalities were mild (91%). DLCO was abnormal in 27. Reductions were mild in 96%. Patients with a history of relapse were more likely to develop abnormalities in spirometry and/or DLCO (odds ratio=5.02, 95% confidence interval: 1.3-19.4, P=0.01; odds ratio=3.47, 95% confidence interval: 1.01-11.9, P=0.03). Asymptomatic abnormalities of PFT are common among childhood cancer survivors treated with bleomycin and associated with a history of relapse. Research studying the risk for clinical progression of this dysfunction is warranted.
肺部疾病在儿童癌症幸存者中是一种严重的发病情况。本研究的目的是描述接受博来霉素治疗的儿童癌症幸存者所经历的肺功能障碍。对接受博来霉素治疗的幸存者进行了肺功能测试（PFT）的横断面分析。评估了最近一次治疗后的PFT。肺活量测定和肺容积被分类为正常、限制性、阻塞性或混合性。一氧化碳弥散量（DLCO）被分类为正常或异常。分析了143名幸存者的PFT数据。PFT在治疗结束后的中位时间为2.3年（四分位间距，1.4至4.9年）进行。肺活量测定异常的有58人（41%），只有5人（9%）有呼吸道症状。42人（70%）有阻塞性通气缺陷，11人（18%）有限制性通气缺陷，5人（9%）有混合性通气缺陷。大多数异常情况为轻度（91%）。DLCO异常的有27人。96%的降低程度为轻度。有复发史的患者更有可能出现肺活量测定和/或DLCO异常（比值比=5.02，95%置信区间：1.3 - 19.4，P = 0.01；比值比=3.47，95%置信区间：1.01 - 11.9，P = 0.03）。在接受博来霉素治疗的儿童癌症幸存者中，PFT无症状异常很常见，且与复发史有关。有必要开展研究以探讨这种功能障碍临床进展的风险。
