急性淋巴细胞白血病患儿血小板输注疗效及影响因素分析

目的探讨急性淋巴细胞白血病(ALL)患儿血小板输注的疗效及其影响因素。方法纳入2013年1月1日至2016年6月30日在中南大学湘雅三医院血液科及儿科就诊的全部初诊、初治,且在治疗过程中至少输注1次单采血小板的、14岁的ALL患儿。单采血小板的输注采用ABO、Rh同型输注策略。每例每次输注血小板后同时满足24 h校正血小板增加指数(CCI)4.5和24 h血小板回收率(PPR)20%,且消化道、鼻和牙龈出血症状得到控制,判定为当次输注有效,否则为当次输注无效。有效例次归为有效组,无效例次归为无效组。对可能影响血小板输注疗效的因素(年龄、性别、发热、出血、脾大、感染、是否使用头孢菌素、血小板输注次数)行单因素和多因素分析。结果 44例ALL患儿进入本文分析,共输注单采血小板302例次,有效组197例次(65.2%),无效组105例次,每例患儿平均输注(6.1±5.6)次。302例次中;输注血小板前后的血小板计数(×10~9·L~(-1))分别为19.2±9.4和66.1±36.2,差异有统计学意义(t=11.19,P0.01);输注1次(44例次)、~5次(93例次)、~10次(67例次)和10次(98例次)的输注有效率分别为84.1%、76.3%、56.7%和52.0%。单因素分析显示,有效组和无效组比较,发热、出血、脾大、感染和血小板输注次数差异有统计学意义,P均0.05。Logistic多因素回归分析显示,发热(OR=3.737,95%CI:1.213~11.513)和感染(OR=3.258;95%CI:1.019~10.419)是影响血小板输注疗效的主要危险因素。结论血小板输注可以改善ALL患儿的血小板计数及出血症状,发热和感染为影响ALL患儿血小板输注疗效的主要危险因素。

Clinical efficacy and influencing factors of platelet transfusion in children with acute lymphoblastic leukemia

Objective: To analyze the clinical efficacy and influencing factors of platelet transfusion in children with acute lymphoblastic leukemia(ALL).Methods: From January 1st, 2013 to June 30th, 2016 , ALL patients younger than 14 years old with initial diagnosis and treatment in hematology department or pediatrics department of the Third Xiangya Hospital of Central South University were recruited in this study, and they had at least once apheresis platelets (APs) transfusion. They all infused APs that had same group of ABO and Rh with themselves. The clinical efficacy was evaluated by 24 h corrected count increment(CCI), percentage plate recovery(PPR) and clinical symptoms. The patients with CCI＞4.5, PPR＞20% and the hemorrhage symptom controlled were defined as effective, if not, they were defined as noneffective. The factors that may influence efficacy (including age, gender, fever, hemorrhage, splenomegaly, infection, using cephalosporins and times of platelet transfusion) were analyzed. Results: Total 302 times of platelet transfusion were performed in 44 patients, the average time of each patients was (6.1±5.6). 197 times of transfusion were effective (65.2%), the other 105 times were noneffective. The platelet counts before and after platelet transfusion were (19.2±9.4)×109·L-1 and (66.1±36.2)×109·L-1, it was significant increased (t=11.19，P＜0.01). The effective rates of once (n=44), 2-5 times (n=93), 6-10 times(n=67) and more than 10 times (n=98) were 84.1%, 76.3%, 56.7% and 52.0%, respectively. Patients with fever, hemorrhage, splenomegaly, infection and transfusion repeatedly had a poor efficacy than the patients without these factors (P＜0.05). The above factors were analyzed by multivariate logistic regression, it showed that fever (OR=3.737, 95%CI:1.213 to 11.513) and infusion (OR=3.258, 95%CI:1.019 to 10.419) were independent risk factors.Conclusion: The platelet count and clinical symptoms were significantly improved after platelet transfusion. Fever and infection were the main risk factors of clinical efficacy of platelet transfusion in children with ALL.