| ObjectiveTo analyze and study the clinical and characteristics and risk factors of paralytic ileus in children with acute lymphoblastic leukemia(acute lymphoblastic leukemia,ALL)and solid tumor after chemotherapy with vincristine.Therefore,the high risk population with vincristine chemotherapy-associated paralytic intestinal obstruction can be identified early,intervene as early as possible and improve the prognosis.Methods(1)A total of 323cases(including 252 cases of ALL and 71 cases of solid tumor)and 2540 case-times of vincristine chemotherapy in pediatrics of NanFang Hospital from January 2015 to June 2018 were carried out.After evaluating,a total of 40 cases with paralytic ileus after vincristine chemotherapy were diagnosed with abdominal orthostatic film in the course,and their clinical data were collected to study the risk factors of paralytic ileus after vincristine chemotherapy,and to explore the relationship between the risk factors and diagnosis,sex,age,BMI,the immunophenotype,risk stratification and treatment stage of ALL,the levels of CRP and albumin,as well as the use of anti-fungal agents or not.(2)All statistical analysis was analyzed by SPSS version 22.0.A P value of<0.05 was considered to be statistically significant.Results(1)Of the newly diagnosed cases,the incidence of paralytic intestinal obstruction was 12.4%(40/323)in 323 children.In univariate analysis,252 children with ALL were classified as risk groups.The incidence of low risk children,who were diagnosed of ALL was 5.7%(8/140),middle risk children was 16.3%(17/104)and high risk children was 25%(2/8).The difference was statistically significant(χ2=9.220,P=0.009 after correction).There was no significant difference in types of disease,the age of diagnosis,sex and BMI.(2)Univariate analysis of 2540 case-times of vincristine chemotherapy showed that the levels of C reactive protein and albumin were significantly different.In addition,the incidence of paralytic ileus was 2.6%(18/688)during induction remission,0.8%(7/863)during interim and 0.3%(2/654)during maintenance,the difference was statistically significant(P<0.001).And a statistically significant difference(P<0.001)with the combination of triazole anti-fungal agents(8.6%vs1.2%)during vincristine chemotherapy(P<0.05).(3)Logistic regression analysis showed that the level of CRP(≥5mg/dl)and serum albumin(<35g/l),the combine use of triazole anti-fungal agents during chemotherapy as well as the risk stratification and the treatment stage of ALL were closely related to paralytic ileus associated with vincristine chemotherapy(P<0.05).ConclusionIn children with vincristine chemotherapy,the risk of paralytic ileus was increased after combined with elevated CRP(≥5mg/dl)and hypoalbuminemia(serum albumin<35g/l).The probability of paralytic ileus was higher when the combination with triazole anti-fungal agents such as itraconazole,volconazole,posaconazoleand fluconazole during chemotherapy.In addition,the incidence of paralytic ileus was the highest during induction remission with ALL,and in intermediate risk group was higher than that in low risk group.As for the paralytic ileus children,most of them showed the first symptoms were abdominal pain,abdominal distension,accompanied withvomitingor not,decreased defecation,etc.The diagnosis could be confirmed by the method of abdominal orthostatic film.After diagnosis,most of them can be relieved after giving fasting,gastrointestinal decompression,enemata,keep defecation unobstructed,anti-infection and other symptomatic treatment. |
