长春新碱诱导的周围神经病变的儿童队列研究

A cohort study of vincristine-induced peripheral neuropathy in children

摘要:

目的 总结急性淋巴细胞白血病（acute lymphoblastic leukemia，ALL）患儿发生长春新碱诱导的周围神经病变（vincristine-induced peripheral neuropathy，VIPN）的特征，探讨VIPN发生的影响因素。方法 选择2018年1月—2022年2月于贵州医科大学附属医院使用CCCG-ALL2015或CCCG-ALL2020方案治疗的1~18岁ALL患儿为研究对象，根据治疗方案中年龄对危险度分组的影响，将患儿分为1~10岁组（91例）和>10岁组（29例），并根据国家癌症研究所不良事件通用术语标准第5版，对发生的VIPN进行分级评估，比较不同组间在VIPN发生率、严重程度、类型上的差异。结果 共纳入120例患儿，56例发生VIPN，发生率为46.7％。>10岁组患儿VIPN发生率高于1~10岁组（69％ vs 40％，P<0.05）。在发生VIPN患儿中，3级及以上VIPN 12例（21％），2级VIPN 44例（79％）。自主神经症状77例次（59.7％）、周围神经损伤42例次（32.5％）、颅神经损伤10例次（7.8％）。不同年龄、性别、危险度、治疗方案组别的VIPN严重程度及类型比较差异无统计学意义（P>0.05）。二元logistic回归分析结果显示，年龄是VIPN发生的影响因素（P<0.05）。结论 儿童ALL患儿中，VIPN发生率较高，自主神经症状发生率最高；10岁以上患儿VIPN发生率较高。

Abstract:

Objective To study the characteristics of vincristine-induced peripheral neuropathy (VIPN) in children with acute lymphoblastic leukemia (ALL) and the factors influencing the development of VIPN.Methods The children with ALL, aged 1-18 years, who were treated with CCCG-ALL2015 or CCCG-ALL2020 regimen in the Affiliated Hospital of Guizhou Medical University from January 2018 to February 2022 were enrolled as subjects. According to the influence of age on risk, the children were divided into 1-10 years group with 91 children and >10 years group with 29 children. VIPN was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (5th edition), and the incidence rate, severity, and type of VIPN were compared between different groups.Results A total of 120 children were enrolled in this study, among whom 56 (46.7%) developed VIPN. The >10 years group had a significantly higher incidence rate of VIPN than the 1-10 years group (69% vs 40%, P<0.05). Among the 56 children with VIPN, 12 (21%) had grade 3 VIPN or above, and 44 (79%) had grade 2 VIPN. There were 77 cases of autonomic nerve symptoms (59.7%), 42 cases of peripheral nerve injury (32.5%), and 10 cases of cranial nerve injury (7.8%). There were no significant differences in the severity and type of VIPN between the groups with different ages, sexes, degrees of risk, or treatment regimens (P>0.05). The results of binary logistic regression analysis showed that age is the influencing factor for the occurrence of VIPN (P>0.05).Conclusions There is a relatively high incidence rate of VIPN in children with ALL, with the highest incidence rate of autonomic nervous symptoms. The incidence of VIP in children over 10 years old is relatively high.