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The overall survival rate of children with acute myeloid leukemia(AML) is significantly lower than that of acute lymphoblastic leukemia.The main causes of death include primary disease-related death and treatment-related death.Most of the treatment-related deaths are caused by infection, bleeding and organ failure.Infection is the most common complication of pediatric AML during the myelosuppression period after chemotherapy, and it is also the main cause of early death in AML.Based on the analysis of pathogens, laboratory tests and risk factors, this paper reviews the clinical characteristics and research progress of infection in myelosuppression following chemotherapy for AML, so as to provide a basis for early identification, clinical management and condition judgment, and further improve the survival rate of children with AML.
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Objective:To analyze the early risk warning factors of clinical characteristics in children with acute lymphoblastic leukemia (ALL) complicated with acute pancreatitis (AP).Methods:Retrospective study.A total of 39 children with ALL complicated with AP admitted to the Hematology Center of Beijing Children′s Hospital, Capi-tal Medical University from May 2018 to December 2020 were selected as the case group, and 78 ALL patients were randomly selected as the control group according to the exact matching of 1∶2 of the same age and sex.The measurment data and counting data were analyzed by Rank sum test ( Mann Whitney U test) and χ2 test between the 2 groups, respectively, and further multivariate Logistic regression analysis was performed to find out the risk factors of ALL complicated with pancreatitis.At the same time, the relationship between each index and severity was explored. Results:The incidence of ALL complicated with AP was 8.55% (39/456 cases). The high incidence age was 3-10 years old.Sixty-four point nine percent (24/37 cases) of the pancreatitis occurred in the early stage of chemotherapy, and 66.7% (26/39 cases) was associated with asparaginase.There were significant differences in ALL risk stratification ( χ2=21.404, P<0.001), C-reactive protein (CRP)( U=232.000, P<0.001), procalcitonin (PCT)( t=3.950, P<0.001), hematocrit( t=3.981, P<0.001), serum calcium( t=-9.609, P<0.001), indirect bilirubin( U=1 142.000, P<0.05), triglyceride( t=3.600, P=0.001) and albumin( t=-6.296, P<0.001) between the 2 groups.The sensitivity of abdominal CT, abdominal ultrasound and pancreatic magnetic resonance imaging in the case group were 70.8%, 81.6% and 100.0%, respectively.Multivariate Logistic regression analysis showed that differences between albumin( OR=11.444, 95% CI: 3.240-40.423), triglyceride( OR=18.047, 95% CI: 5.020-65.074) and risk stra-tification( OR=8.894, 95% CI: 1.889-41.885) were statistically significant, and there were obvious differences in PCT( U=3.000, 2.000, all P<0.05) and serum calcium( U=4.500, 8.500, all P<0.05) between patients with severe pancreatitis and patients with mild or moderate severe pancreatitis. Conclusions:ALL complicated with AP often occurs in the early stage of chemotherapy, mainly caused by asparaginase.In imaging examination, the sensitivity of pancreatic magnetic resonance imaging is the highest, followed by abdominal ultrasound.Risk stratification, decreased albumin and elevated triglyceride are risk factors of ALL complicated with AP, which are helpful for early identification of high-risk patients with ALL complicated with AP.PCT and serum calcium may play an important role in severe pancreatitis.
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Objective To study the clinical significance of CD4 + CD25+ Foxp3 + regulatory T cell (Treg) and interleukin 10 (IL-10),transforming growth factor-β1 (TGF-β 1) in patients with steroidresistant asthma (SRA).Methods Seventy-nine patients with asthma were divided into SRA group (31cases) and steroid-sensitive (SSA) group (48 cases).Forty-five healthy subjects were selected simultaneously as control group.CD4+ CD25+ Foxp3 +Treg level was detected by flow cytometry and serum IL-10 and TGF-β1 levels were detected by enzyme-linked immunosorbent assay.Results The percentage of CD4 + CD25 +Foxp3 +Treg in CD4+ T cell and its absolute value in SRA group and SSA group were 0.0225 ± 0.0063,(1.09 ± 0.23) × 107/L and 0.0345 ± 0.0094,(1.35 ± 0.14) × 107/L,they were significandy lower than those in control group [0.0537 ± 0.0128,(2.06 ± 0.27) × 107/L],and SRA group was significandy lower than SSA group,there were statistical differences (P ＜ 0.05).The levels of serum TGF-β1 in SRA group and SSA group were significantly lower than those in control group [(138.12 ± 23.26),(176.25 ± 40.37) ng/L vs.(281.22 ±47.15) ng/L],there was statistical difference (P ＜0.05).The levels of serum IL-10 in SRA group was significantly lower than that in control group [(516.43 ± 86.33)ng/L vs.(763.02 ± 90.19) ng/L],there was statistical difference (P ＜ 0.05).There was no statistical difference in the level of serum IL-10 between SSA group and control group (P ＞ 0.05).The levels of serum IL-10 and TGF-β 1 in SRA group were significantly lower than those in SSA group,there were statistical differences (P ＜ 0.05).The levels of serum IL-10 and TGF-β1 had positive correlation with CD4 + CD25 + Foxp3 +Treg in SRA group and SSA group (P ＜ 0.01).Conclusion The interaction among CD4+ CD25+ Foxp3 +Treg,IL-10 and TGF-β1 may play an important role in the SRA occurrence and development,while by increasing peripheral blood CD4 + CD25 + Foxp3 +Treg number and stabilizing its function can increase IL-10 and TGF-β1 expression,which may be an important way to treat SRA.