目的 分析急性淋巴细胞白血病(ALL)儿童接受培门冬酶治疗后发生门冬酰胺酶相关胰腺炎(AAP)的高危因素，以及评估儿童序贯器官衰竭评估(SOFA)评分、儿童急性胰腺炎(PAPS)评分、Ranson′s评分及日本儿童量表(JPN)评分对AAP严重程度的预测价值。 方法 横断面研究。收集2014年1月至2021年8月在南方医科大学珠江医院小儿血液科接受培门冬酶治疗的328例ALL患儿的临床资料及AAP患儿的临床表现、实验室检查和影像学检查。计算确诊AAP时的儿童SOFA评分、确诊48 h时的PAPS评分和Ranson′s评分、确诊72 h时的儿童JPN评分，利用受试者工作特征曲线(ROC曲线)评估其对重症AAP的预测效能。 结果 AAP发生率为6。7%(22/328)，中位年龄6。62岁，最常发生于诱导缓解阶段(16/22，72。7%)，3例AAP患儿再次暴露于门冬酰胺酶，其中有2例发生了第2次AAP。22例AAP患儿中，轻症AAP 16例，重症AAP 6例，其中转儿童重症监护室(PICU)治疗6例，均为重症AAP。AAP组在性别、初诊白细胞数、ALL的免疫分型、危险分层及培门冬酶单次剂量方面与非AAP组比较差异均无统计学意义(均P>0。05)，AAP组的ALL诊断年龄明显大于非AAP组(t＝2。385，P＝0。018)，AAP组的超重或肥胖例数也多于非AAP组(χ2＝4。507，P＝0。034)。儿童JPN评分、儿童SOFA评分、Ranson′s评分和PAPS评分预测重症AAP的ROC曲线下面积(AUC)分别为0。919、0。844、0。731和0。606，儿童JPN评分(t＝4。174，P＝0。001)、儿童SOFA评分(t＝3。181，P＝0。005)在轻症与重症AAP组间差异有统计学意义。 结论 AAP是培门冬酶联合化疗治疗ALL过程中的严重并发症，年龄较大、超重或肥胖可能是AAP的高危因素，儿童JPN评分、儿童SOFA评分对重症AAP有预测价值。 Objective To analyze the risk factors for asparaginase-associated pancreatitis (AAP) in children with acute lymphoblastic leukemia (ALL) after treatment with pegaspargase and evaluate the predictive value of pediatric sequential organ failure assessment (SOFA) score， pediatric acute pancreatitis severity (PAPS) score， Ranson′s score and pediatric Ministry of Health， Labour and Welfare of Japan (JPN) score for severe AAP。 Methods Cross-sectional study。The clinical data of 328 children with ALL who received pegaspargase treatment in the Department of Pediatric Hematology， Zhujiang Hospital， Southern Medical University from January 2014 to August 2021， as well as their clinical manifestations， laboratory examinations， and imaging examinations were collected。The SOFA score at the time of AAP diagnosis， PAPS score and Ranson′s score at 48 hours after AAP diagnosis， and JPN score at 72 hours after AAP diagnosis were calculated， and their predictive value for severe AAP was evaluated by the receiver operating characteristic (ROC) curve。 Results A total of 6。7%(22/328) of children had AAP， with the median age of 6。62 years。AAP most commonly occurred in the induced remission phase (16/22， 72。7%)。 Three AAP children were re-exposed to asparaginase， and 2 of them developed a second AAP。Among the 22 AAP children， 16 presented with mild symptoms， and 6 with severe symptoms。The 6 children with severe AAP were all transferred to the Pediatric Intensive Care Unit (PICU)。 There were no significant differences in gender， white blood cell count at first diagnosis， immunophenotype， risk stratification， and single dose of pegaspargase between the AAP and non-AAP groups。The age at diagnosis of ALL in the AAP group was significantly higher than that in the non-AAP group (t=2。385， P=0。018)。 The number of overweight or obese children in the AAP group was also higher than that in the non-AAP group (χ2=4。507， P=0。034)。 The areas under the ROC curve of children′s JPN score， SOFA score， Ranson′s score， and PAPS score in predicting severe AAP were 0。919， 0。844， 0。731， and 0。606， respectively。The JPN score (t=4。174， P=0。001) and the SOFA score (t=3。181， P=0。005) showed statistically significant differences between mild and severe AAP。 Conclusions AAP is a serious complication in the treatment of ALL with combined pegaspargase and chemotherapy。Older age and overweight or obesity may be the risk factors for AAP。Pediatric JPN and SOFA scores have predictive value for severe AAP。
Analysis of risk factors and severity prediction of acute pancreatitis induced by pegaspargase in children
Objective To analyze the risk factors for asparaginase-associated pancreatitis (AAP) in children with acute lymphoblastic leukemia (ALL) after treatment with pegaspargase and evaluate the predictive value of pediatric sequential organ failure assessment (SOFA) score, pediatric acute pancreatitis severity (PAPS) score, Ranson′s score and pediatric Ministry of Health, Labour and Welfare of Japan (JPN) score for severe AAP. Methods Cross-sectional study.The clinical data of 328 children with ALL who received pegaspargase treatment in the Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University from January 2014 to August 2021, as well as their clinical manifestations, laboratory examinations, and imaging examinations were collected.The SOFA score at the time of AAP diagnosis, PAPS score and Ranson′s score at 48 hours after AAP diagnosis, and JPN score at 72 hours after AAP diagnosis were calculated, and their predictive value for severe AAP was evaluated by the receiver operating characteristic (ROC) curve. Results A total of 6.7%(22/328) of children had AAP, with the median age of 6.62 years.AAP most commonly occurred in the induced remission phase (16/22, 72.7%). Three AAP children were re-exposed to asparaginase, and 2 of them developed a second AAP.Among the 22 AAP children, 16 presented with mild symptoms, and 6 with severe symptoms.The 6 children with severe AAP were all transferred to the Pediatric Intensive Care Unit (PICU). There were no significant differences in gender, white blood cell count at first diagnosis, immunophenotype, risk stratification, and single dose of pegaspargase between the AAP and non-AAP groups.The age at diagnosis of ALL in the AAP group was significantly higher than that in the non-AAP group (t=2.385, P=0.018). The number of overweight or obese children in the AAP group was also higher than that in the non-AAP group (χ2=4.507, P=0.034). The areas under the ROC curve of children′s JPN score, SOFA score, Ranson′s score, and PAPS score in predicting severe AAP were 0.919, 0.844, 0.731, and 0.606, respectively.The JPN score (t=4.174, P=0.001) and the SOFA score (t=3.181, P=0.005) showed statistically significant differences between mild and severe AAP. Conclusions AAP is a serious complication in the treatment of ALL with combined pegaspargase and chemotherapy.Older age and overweight or obesity may be the risk factors for AAP.Pediatric JPN and SOFA scores have predictive value for severe AAP.
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