化疗相关性高血糖对儿童急性淋巴细胞白血病预后的影响简

本研究探讨急性淋巴细胞白血病儿童诱导及再诱导治疗期间发生化疗相关性高血糖对预后的影响.对中山大学孙逸仙纪念医院儿科2008年6月-2012年5月160名初发ALL患儿的临床资料进行了回顾性分析.随访至2013年5月,中位随访时间为2.6年（0.08-4.9年）.根据含有左旋门冬酰胺酶（L-asp）及地塞米松两种药物化疗期间的血糖值将患儿分为高血糖组及无高血糖组,采用x2检验分析高血糖的好发因素,Kaplan-Meier法及对数秩检验比较高血糖组与无高血糖组的5年总体生存率及无复发率.结果表明,高年龄组（≥10岁）患儿高血糖的发生率高于低年龄组（43.33％vs19.23％）,差别有统计学意义（P=0.008）,且中、高危组的化疗相关性高血糖发生率高于低危组（26.62％vs4.76％,P=0.017）,而与性别相关性无统计学意义（P=0.059）;高血糖组患儿的5年总体生存率为83.1±6.3％,低于无高血糖组患儿（94.2±2.9％）（P=0.014）;高血糖组的5年无复发率（64.1±8.9％）明显低于无高血糖组（88.6±3.8％）（P＜0.001）.结论：高年龄（≥10岁）、中高危ALL患儿易发生化疗相关性高血糖,高血糖患儿的5年总体生存率及无复发率均低于无高血糖组.

Hyperglycemia During Chemotherapy Influences the Prognosis of Children with Acute Lymphocytic Leukemia

This study was aimed to explore whether hyperglycemia during chemotherapy influences the prognosis of children with acute lymphocytic leukemia（ALL）.The clinical medical records of all newly diagnosed patients with ALL at SUN Yat-Sen Memorial Hospital from June 2008 to May 2012 were analyzed retrospectively.The median time of follow-up for patients was 2.6 years （range 0.08 to 4.9 years）.Patients were divided to hyperglycemia and euglycemia groups according to their blood glucose concentrations during chemotherapy which contains L-asp and dexamethasone.The variables between two groups were compared using x2 test,the RFS and OS among two groups were compared by use of Kaplan-Meier and Cox-proportional hazard analyses.The results showed that the hyperglycemia correlated with older age（43.33％ vs 19.23％,P =0.008） and high-risk disease at diagnosis（26.62％ vs 4.76％,P =0.017）,but did not associate with sex（P =0.059）.Patients with hyperglycemia had worse OS （94.2 ± 2.9％ vs 83.1 ± 6.3％,P =0.014） and more poor RFS （64.1 ± 8.9％ vs 88.6 ± 3.8％,P ＜0.001） at 5 years than their counterpart.It is concluded that the incidence rate of hyperglycemia during chemotherapy correlated with older age and high-risk disease in ALL children,and the patients with hyperglycemia during chemotherapy may have poorer prognosis.