埃及上埃及地区接受强化化疗的小儿白血病患者中的中性粒细胞减少性小肠结肠炎。

Neutropenic enterocolitis in pediatric leukemia patients treated with intensive chemotherapy in Upper Egypt.

作者信息

Fouad Ereen Refaat, Morsy Ahmed Mohammed, Kamel Hosam Eldein Mostafa, Ali Amany Mohamed

机构信息

Department of Pediatric Oncology South Egypt Cancer Institute Assiut University Assiut Egypt.

Department of Radiology South Egypt Cancer Institute Assiut University Assiut Egypt.

出版信息

Pediatr Investig. 2020 Mar 17;4(1):5-10. doi: 10.1002/ped4.12174. eCollection 2020 Mar.

DOI:10.1002/ped4.12174

PMID:32851335

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7331293/

Abstract

IMPORTANCE

In low resource countries, there has been scarcity of research on the risk factors associated with neutropenic enterocolitis, a serious complication that commonly develops during treatment of cancer patients.

OBJECTIVE

To identify the pattern of intestinal complications in pediatric leukemia patients treated with intensive chemotherapy, including those with neutropenic enterocolitis; to assess the outcome; and to evaluate the risk factors associated with the mortality in these patients.

METHODS

During the period from June 2015 to December 2016, a prospective study was carried out on pediatric patients diagnosed with acute leukemia who received induction/or re-induction phases of chemotherapy at South Egypt Cancer Institute. Patients with documented episodes of intestinal complications were included in the study. Recovery or death from an episode of intestinal complication was utilized as the primary outcome measure for the study. Using univariable and multivariable methods, potential risk factors associated with mortality were delineated by logistic regression analysis, both for the entire intestinal complications episodes as a whole and for those episodes of neutropenic enterocolitis only.

RESULTS

Out of 88 documented episodes of intestinal complications from 77 patients; 58 episodes were identified as neutropenic enterocolitis from 47 patients. In those patients who were having episodes of neutropenic enterocolitis, the presence of abdominal tenderness ( 4.529, 95% 1.062-19.317, 0.041); a longer duration of neutropenia ( 1.215, 95% 1.030-1.434, 0.021); and hemodynamic instability ( 17.023, 95% 4.095-70.772, 0.001), were found to be independently associated with worse outcome.

INTERPRETATION

In Upper Egypt, the use of intensive systemic chemotherapy during the induction phase of acute leukemia was found to be associated with potentially lethal intestinal complications. A high index of clinical suspicion is warranted.

摘要

重要性

在资源匮乏的国家，关于与中性粒细胞减少性小肠结肠炎相关的危险因素的研究较少，中性粒细胞减少性小肠结肠炎是癌症患者治疗期间常见的严重并发症。

目的

确定接受强化化疗的小儿白血病患者肠道并发症的模式，包括患有中性粒细胞减少性小肠结肠炎的患者；评估结局；并评估这些患者死亡的相关危险因素。

方法

2015年6月至2016年12月期间，对在埃及南部癌症研究所接受诱导/再诱导化疗阶段的急性白血病小儿患者进行了一项前瞻性研究。记录有肠道并发症发作的患者纳入研究。肠道并发症发作后的恢复或死亡用作该研究的主要结局指标。使用单变量和多变量方法，通过逻辑回归分析确定与死亡相关的潜在危险因素，既针对整个肠道并发症发作情况，也仅针对中性粒细胞减少性小肠结肠炎发作情况。

结果

在77例患者的88次记录的肠道并发症发作中；47例患者的58次发作被确定为中性粒细胞减少性小肠结肠炎。在患有中性粒细胞减少性小肠结肠炎发作的患者中，发现腹部压痛（4.529，95%置信区间1.062 - 19.317，P = 0.041）；中性粒细胞减少持续时间较长（1.215，95%置信区间1.030 - 1.434，P = 0.021）；以及血流动力学不稳定（17.023，95%置信区间4.095 - 70.772，P = 0.001）与较差结局独立相关。