芒硝外敷预防急性淋巴细胞白血病儿童二次门冬酰胺酶相关性胰腺炎的临床观察OA
Clinical observation of external application of mirabilite in preventing second asparaginase‑associated pancreatitis in children with acute lymphoblastic leukemia
目的 观察芒硝外敷预防急性淋巴细胞白血病儿童二次门冬酰胺酶(ASP)相关性胰腺炎(AAP)的临床疗效和安全性.方法 将54例发生首次AAP后继续接受ASP治疗的急性淋巴细胞白血病患儿按照1∶2的比例随机分为治疗组(n=18)、对照组(n=36),治疗组自ASP再暴露当日开始给予芒硝外敷,持续2周,对照组不给予任何预防性干预措施.观察两组二次AAP的发生情况及芒硝外敷的安全性,比较血清胰酶、炎症指标[白细胞介素(IL)-6、IL-10、C反应蛋白(CRP)、乳酸脱氢酶(LDH)]、肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)]的变化情况;采用多因素logistic回归分析探讨发生二次AAP的危险因素.结果 ①治疗组二次AAP发生率(11.11%)低于对照组(44.44%),差异有统计学意义(P＜0.05).②治疗前后组内比较,治疗组LDH水平降低(P＜0.05),对照组血清淀粉酶、脂肪酶、IL-6、ALT、AST、TBil水平升高(P＜0.05);组间治疗后比较,治疗组血清淀粉酶、脂肪酶、LDH、ALT、AST、TBil水平低于对照组(P＜0.05).③多因素logistic回归显示,ASP再暴露后血清高水平的TBil是发生二次AAP的独立危险因素[HR=1.322,95%CI(1.06～1.66),P＜0.05].④试验过程中,未观察到芒硝外敷相关不良反应.结论 芒硝外敷对急性淋巴细胞白血病患儿二次 AAP具有预防作用,且操作简便,无明显不良反应,其机制可能与促进胆汁排泄有关.
Objective To observe the clinical efficacy and safety of external application of mirabilite in preventing second asparaginase-associated pancreatitis(AAP)in children with acute lymphoblastic leukemia(ALL).Methods Fifty-four children with ALL who developed first-episode AAP and continued to receive ASP therapy were randomly divided into a treatment group(n=18)and a control group(n=36)at a 1∶2 ratio.The treatment group received external application of mirabilite starting on the day of ASP re-exposure,lasting for 2 weeks;the control group received no prophylactic interventions.The incidence of second AAP and safety of mirabilite external application were observed.Changes in serum pancreatic enzymes,inflammatory markers[interleukin(IL)-6,IL-10,C-reactive protein(CRP),and lactate dehydrogenase(LDH)],and liver function indicators[alanine transaminase(ALT),aspartate transaminase(AST),and total bilirubin(TBil)]were compared.Additionally,multivariate logistic regression analysis was used to identify risk factors for the development of second AAP.Results ① The incidence of second AAP was significantly lower in the treatment group(11.11%)than in the control group(44.44%),and the difference was statistically significant(P＜0.05).②Intragroup comparisons showed that LDH levels decreased in the treatment group after treatment(P＜0.05),while serum amylase,lipase,IL-6,ALT,AST,and TBil levels increased in the control group(P＜0.05).Post-treatment intergroup comparisons showed that the treatment group had lower levels of serum amylase,lipase,LDH,ALT,AST,and TBil than the control group(P＜0.05).③Multivariate logistic regression analysis showed that high serum TBil level after ASP re-exposure was an independent risk factor for the development of second AAP[HR=1.322,95%CI(1.06-1.66),P＜0.05].④ No adverse reactions related to external application of mirabilite were observed during the trial.Conclusions External application of mirabilite can prevent a second AAP in children with ALL,with easy operation and no obvious adverse reactions.Its mechanism may be associated with promoting bile excretion.
TANG Huijiao;ZHANG Tian'ao;DENG Zhaohui
Department of Pediatric Gastroenterology,Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,ChinaDepartment of Pediatric Gastroenterology,Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,ChinaDepartment of Pediatric Gastroenterology,Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China
急性淋巴细胞白血病儿童门冬酰胺酶胰腺炎芒硝中药临床研究
acute lymphoblastic leukemiachildrenasparaginasepancreatitismirabiliteChinese materia medicaclinical research
《上海中医药杂志》 2026 (1)
57-63,7
上海市科委2021年度"科技创新行动计划"医学创新研究专项(22Y11921800)
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