Lin Jia-Le, Liu Kang-Kang, Chu Jin-Hua, Huang Ling-Ling, Xie Zhi-Wei, Yang Lin-Hai, Tu Song-Ji, Wang Ning-Ling
Department of Paediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China.
Department of Paediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Jun;28(3):767-774. doi: 10.19746/j.cnki.issn.1009-2137.2020.03.009.
To study the risk factors and infection characteristics of nosocomial infection in children with acute lymphoblastic leukemia (ALL) and analyze the relationship between different nutritional status and nosocomial infection, early treatment response.
The clinical data of 133 children with ALL treated with CCCG-ALL-2015 from June 2016 to June 2019 (chemotherapy stage, risk level, MRD), infection during hospitalization (course of infection, laboratory indicators, sites of infection, outcome) and nutritional status (sex, age, height/ length, weight) were enrolled. The Chi 2 test and Logistic regression analysis were used for statistical analysis.
The rate of nosocomial infection was 19.9% in 133 children with ALL, in which 3 were infection-related death. Sex, immunophenotype and risk showed no significantly affect on the occurrence of nosocomial infection (P＞0.05), but neutrophil count, hemoglobin level, platelet count, chemotherapy stage, length of stay in hospital and nutritional status showed affect on the occurrence of nosocomial infection (P＜0.05). Logistic multivariate regression analysis showed that chemotherapy stage, length of hospital stay, neutrophils and nutritional status were the independent risk factors, in which the respiratory tract infection was the most common. Gram-positive bacteria, Gram-negative bacteria and fungi accounted for 44.1%, 52.9% and 2.9% respectively. The negative rate of MRD in day 19 and day 46 between different nutritional status groups showed statistically significant (P＜0.05).
Neutrophil count, chemotherapy stage, length of stay in hospital and nutritional status are independent risk factors for nosocomial infection. Among of them, nutritional status negatively correlated with nosocomial infection, and the poorer nutritional status, the higher risk of nosocomial infection. Malnutrition, overweight and obesity can affect the early treatment response of ALL children. The level of nutrition at first diagnosis can be used as a bad factor to evaluate the early treatment response of ALL children.
探讨急性淋巴细胞白血病（ALL）患儿医院感染的危险因素及感染特点，分析不同营养状况与医院感染、早期治疗反应的关系。
纳入2016年6月至2019年6月采用CCCG-ALL-2015方案治疗的133例ALL患儿的临床资料（化疗阶段、危险度、微小残留病）、住院期间感染情况（感染病程、实验室指标、感染部位、转归）及营养状况（性别、年龄、身高/身长、体重）。采用χ²检验和Logistic回归分析进行统计学分析。
133例ALL患儿医院感染率为1９.9%，其中3例因感染死亡。性别、免疫表型及危险度对医院感染发生率无显著影响（P＞0.05），而中性粒细胞计数、血红蛋白水平、血小板计数、化疗阶段、住院时间及营养状况对医院感染发生率有影响（P＜0.05）。Logistic多因素回归分析显示，化疗阶段、住院时间、中性粒细胞及营养状况是独立危险因素，其中呼吸道感染最为常见。革兰阳性菌、革兰阴性菌和真菌分别占44.1%、52.9%和2.9%。不同营养状况组第19天和第46天微小残留病阴性率差异有统计学意义（P＜0.05）。
中性粒细胞计数、化疗阶段、住院时间及营养状况是医院感染的独立危险因素。其中，营养状况与医院感染呈负相关关系，营养状况越差，医院感染风险越高。营养不良、超重及肥胖均会影响ALL患儿的早期治疗反应。初诊时的营养水平可作为评估ALL患儿早期治疗反应的不良因素。
