聚乙二醇化重组人粒细胞刺激因子预防儿童急淋白血病化疗后感染的效果

Effect of pegylated recombinant human granulocyte colony-stimulating factor on prevention of infections in children with acute lymphoblastic leukemia after chemotherapy

    摘要
  • 摘要:
    目的 探讨聚乙二醇化重组人粒细胞刺激因子(PEG-rhG-CSF)预防儿童急性淋巴细胞白血病(ALL)化疗后感染的有效性及安全性。
    方法 回顾性收集解放军总医院第一医学中心儿科2018年1月-2024年10月住院接受长春新碱+盐酸柔红霉素+培门冬酶+醋酸泼尼松组成的VDLP诱导缓解化疗的ALL患儿的临床资料，化疗期间分别应用PEG-rhG-CSF或重组人粒细胞刺激因子(rhG-CSF)，比较两组患儿Ⅲ/Ⅳ度粒细胞缺乏发生率、中性粒细胞绝对值最低点、Ⅳ度粒细胞缺乏持续时间、中性粒细胞缺乏伴发热发生率、感染发生情况、抗菌药物使用情况及住院时间。
    结果 共纳入47例ALL(PEG-rhG-CSF组24例，rhG-CSF组23例)患儿。两组患儿Ⅲ/Ⅳ度粒细胞缺乏发生率、骨骼肌肉酸痛发生率比较无统计学差异。与rhG-CSF组相比，PEG-rhG-CSF组患儿中性粒细胞绝对值最低点(0.88±0.87)×109/L更高，同时该组Ⅳ度粒细胞缺乏持续时间2.50(0.00, 6.50) d更短，中性粒细胞缺乏伴发热(41.67%)、感染率(41.67%)及抗菌药物使用比例更低，住院时间更短，差异均有统计学意义(P＜0.05)。
    结论 在儿童ALL诱导缓解化疗中预防性使用PEG-rhG-CSF可提高中性粒细胞最低值、缩短中性粒细胞缺乏持续时间，可降低患儿医院感染率、减少抗菌药物的使用，安全性较好。

     

    Abstract:
    OBJECTIVE To explore the efficacy and safety of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in prevention of infections in the children with acute lymphoblastic leukemia (ALL) after chemotherapy.
    METHODS The clinical data were retrospectively collected from the children with ALL who received vincristine + daunorubicin + pegaspargase + prednisone acetate (VDLP) induction chemotherapy in pediatrics department of the First Medical Center of Chinese PLA General Hospital from Jan. 2018 to Oct. 2024, the children were respectively treated with PEG-rhG-CSF or recombinant human granulocyte colony-stimulating factor (rhG-CSF) during the chemotherapy. The incidence of grade Ⅲ/Ⅳ agranulocytosis, the lowest absolute value of neutrophils, duration of grade Ⅳ agranulocytosis, incidence of agranulocytosis accompanied by fever, incidence of infections, use of antibiotics and length of hospital stay were observed and compared between the two groups.
    RESULTS Totally 47 children with ALL were enrolled in the study and were assigned as the PEG-rhG-CSF group with 24 cases and the rhG-CSF group with 23 cases. There were no significant differences in the incidence rates of grade Ⅲ/Ⅳ agranulocytosis and musculoskeletal soreness between the two groups. The lowest absolute value of neutrophils of the PEG-rhG-CSF group (0.88±0.87)×109/L was higher than that of the rhG-CSF group; the duration of grade Ⅳ agranulocytosis of the PEG-rhG-CSF group 2.50(0.00, 6.50) d was shorter than that of the rhG-CSF group; the incidence of agranulocytosis accompanied by fever (41.67%), incidence of infections (41.67%) and the percentage of children treated with antibiotics were lower in the PEG-rhG-CSF group than in the rhG-CSF group; the length of hospital stay of the PEG-rhG-CSF group was shorter than that of the rhG-CSF group; there were significant differences between the two groups (P < 0.05).
    CONCLUSION The prophylactic use of PEG-rhG-CSF may raise the lowest value of neutrophils, shorten the duration of agranulocytosis, decrease the incidence of hospital-associated infections in the ALL children during the induction chemotherapy, and reduce the use of antibiotics, with the safety favorable.

     

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