儿童急性淋巴细胞白血病并发肿瘤溶解综合征18例临床分析

目的:探讨儿童急性淋巴细胞白血病（acute lymphoblastic leukemia,ALL）并发肿瘤溶解综合征（tumor lysis syndrome,TLS）的临床特点，分析TLS的危险因素以及预后。方法:回顾性收集2015年01月01日至2020年06月30日期间于我院就诊的253例ALL患儿的临床资料。分析TLS的危险因素以及TLS对ALL患儿预后的影响。结果:253例患儿中，18例（7.1%）患儿发生TLS，男女比例2.6∶1，中位年龄8.1岁。TLS患儿较非TLS患儿更容易出现窦性心动过速、前臂心肌复极异常以及QT间期延长（P<0.05）。初诊高白细胞计数（WBC≥50×109/L）与初诊非高白细胞TLS患儿的血尿酸、LDH、血肌酐、血钾、血校正钙及肌酐清除率（creatinine clearance,Ccr）之间没有统计学差异（P>0.05）。多因素分析显示初诊LDH≥900 U/L是TLS发生的独立危险因素。TLS组与非TLS组的EFS及OS没有统计学差异（P>0.05）。结论:初诊LDH≥900 U/L是TLS发生的独立危险因素。TLS并不影响ALL患儿的远期预后。

Clinical analysis of 18 cases of tumor lysis syndrome in childhood acute lymphoblastic leukemia

Objective:To evaluate the clinical features of tumor lysis syndrome(TLS)in childhood acute lymphoblastic leukemia(ALL),and to analyse the risk factors and prognosis of TLS.Methods:Totally 253 children with ALL were included retrospectively who were newly diagnosed in our hospital from January 1st 2015 to June 30th 2020.The risk factors of TLS and the effects of TLS on the prognosis of children with ALL were analyzed.Results:In the 253 children,18 chidfren （7.1%） developed TLS.The ratio of male-female was 2.6∶1 the median age was 8.1 years old.Compared with children without TLS,children with TLS were tend to present with sinus tachycardia,abnormal forearm myocardial repolarization and prolonged QT interval(P<0.05).There was no significant difference between TLS children presenting Hyperleukocytosis(WBC≥50×109/L)and those not presenting hyperleukocytosis in blood uric acid,creatinine,LDH,potassium,calcium correction and Ccr(P>0.05).LDH≥900 U/L was an independent risk factor for TLS.There were no significant differences in EFS and OS in patients with TLS compared to patients without TLS(P>0.05).Conclusion:Children with LDH≥900 U/L has higher incidence of TLS.TLS is not a prognostic factor of EFS and OS in children with ALL.