| Objective: To summarize the occurrence of hepatic injury in the course of chemotherapy in children with acute lymphoblastic leukemia(ALL)and to investigate the risk factors for liver function injury resulting from chemotherapy and other factors.Methods: A retrospective analysis was performed on the clinical data of 74 patients(783 cases)who were treated with chemotherapy in the Department of Pediatrics of the Affiliated Hospital of Qingdao University from June 2015 to June 2017 according to the ALL-CCCG-2015 protocol.Alanine Aminotransferase(ALT),Aspartate Aminotransferase(AST),Alkaline Phosphatase(ALP),and Total Bilirubin(T-Bil)were classified into abnormal liver function according to their degree of increase.Mild hepatic impairment,moderate hepatic impairment,and severe hepatic impairment 4 levels,gender,chemotherapy stage,clinical risk,methotrexate genotype,post-chemotherapy related complications(hemoglobin level,albumin)Levels,infections,and other related factors were analyzed.Results: 1.The incidence of varying degrees of liver damage In 783 children after chemotherapy,a total of 63 386 cases of liver function impairment occurred.The overall incidence of liver injury was 46.99%.According to the degree of injury,the incidence of abnormal liver function was 32.90%,and the incidence of mild liver injury was higher.At 62.43%,the incidence of moderate liver damage was 4.67%,and no severe liver damage was found.2.Effect of different treatment periods on liver function damage After the chemotherapy exclusion window period,it was divided into four phases: induced remission phase,consolidation treatment phase,intermittent treatment,reinduction and maintenance treatment.In all 386 cases of liver injury,liver injury was induced 38 times in remission phase,accounting for 9.84%,including 8 cases of liver dysfunction(21.05%),29 cases of mild liver damage(76.32%),moderate liver damage.1 case(2.63%);Consolidation of 188 cases of liver injury(48.72%)during the treatment period,including 59 cases of liver dysfunction(31.38%),121 cases of mild liver injury(64.37%),moderate liver damage 8 Cases(4.25%);97 cases(25.13%)of hepatic injury during interphase treatment and reinduction chemotherapy,including 30 cases of abnormal liver function(30.93%),66 cases of mild liver damage(68.04%),There were 1 case of moderate hepatic damage(1.03%);53 cases of hepatic injury occurred in maintenance period(13.71%),including 25 cases of liver dysfunction(47.16%),23 cases of mild liver damage(43.40%),moderate liver Damage occurred in 5 cases(9.44%);liver injury occurred in 10 cases without chemotherapy,accounting for 2.60%.No severe liver damage occurred during the above chemotherapy period.The incidence of hepatic damage at each chemotherapy stage was statistically significant(X2=18.518,P<0.05).There was a ignificant difference in the incidence of hepatic injury between the maintenance phase and other chemotherapy phases(P<0.05)(X2=10.314,P=0.006<0.05,compared to the maintenance phase of induction and remission;intermittent treatment and Reinduction compared with maintenance therapy,X2=12.024,P=0.002<0.05);There was no significant difference between induction remission phase,consolidation treatment phase,intermittent treatment and re-induction phase(P>0.05).(X2=2.028,P=0.363>0.05 in induction remission period compared with consolidation treatment period;X2=1.684,P=0.431>0.05 in induction remission period compared with intermittent treatment and re-induction period;consolidation treatment period and intermittent treatment Compared with the re-induction period,X2 = 2.243,P = 0.326> 0.05;Consolidation treatment period compared with maintenance therapy,X2 = 8.055,P = 0.018 <0.05).3.The effect of anemia on liver function damage After chemotherapy,there were 397 cases with no liver injury,158 cases with anemia,239 cases without anemia,386 cases of liver injury after chemotherapy,330 cases of anemia,56 cases of normal hemoglobin,and chemotherapy Whether or not the anemia was combined was statistically significant in the occurrence of hepatic injury(X2=174.02,P=0.000<0.05);in 386 cases of hepatic injury,228 cases were mild anemia,accounting for 59.06%,including 75 cases of abnormal liver function.(32.89%),143 cases of mild liver damage(62.72%),10 cases of moderate liver damage(4.39%);101 cases of moderate anemia,accounting for 26.16%,including 33 cases of abnormal liver function(32.67%)There were 55 cases of mild liver damage(54.46%),13 cases of moderate liver damage(12.87%),and 1 case of severe anemia,accounting for 0.25%,which was abnormal liver function.Mild liver damage was mainly caused by light and moderate anemia,and liver dysfunction was mainly caused by severe anemia.The degree of liver damage was statistically different between the three degrees of anemia(H=9.888,P=0.007<0.05).).4.The effect of serum albumin level on liver function injury After chemotherapy,there were 397 cases without liver injury,178 cases with albumin <35 g/l,219 cases with albumin ≥ 35 g/l,and 386 cases with liver injury after chemotherapy.Albumin <35 g/l Among 77 cases,309 cases had albumin ≥35g/l.Albumin levels after chemotherapy were statistically significant in the occurrence of liver injury(X2=55.20,P=0.000<0.05);386 cases of liver function impairment There were 77 cases of malnutrition(albumin <35g/l),accounting for 19.95%,including 28 cases of abnormal liver function(36.36%),41 cases of mild liver damage(53.25%),moderate liver damage 8 The number of cases(10.39%);albumin normal group(albumin ≥ 35g/l)totaled 309 cases,accounting for 80.05%,of which 99 cases had abnormal liver function(32.03%),and 203 cases had minor liver damage(65.70%).),moderate liver damage in 7 cases(2.27%),malnutrition group and normal group were mainly mild liver damage,albumin levels in the degree of liver damage was statistically significant(X2 = 12.331,P <0.05).5.Effect of infection on liver function damage After chemotherapy,there were 397 cases of liver injury,119 cases of co-infection,278 cases of no infection,386 cases of liver injury after chemotherapy,66 cases of co-infection,320 cases of infection,infection There was statistical significance in the occurrence of hepatic injury(X2=17.98,P=0.001<0.05).Of the 386 cases of hepatic functional impairment,66 were associated with liver function injury,accounting for 17.10%,ncluding 31 cases of abnormal liver function.(47.0%),mild liver damage in 32 cases(48.5%),moderate liver damage in 3 cases(4.5%),no cases of severe liver damage;no infection in 320 cases,accounting for 82.9%,including abnormal liver function 93 Cases(29.1%),212 cases of mild liver damage(66.2%),15 cases of moderate liver damage(4.7%),no severe liver damage;no infection group were mainly mild liver damage,infection There was a statistically significant difference in the degree of liver damage(X2=8.196,P<0.05).6.Multivariate analysis of related risk factors of liver function injury after chemotherapy For the above-mentioned statistically significant single factors(chemotherapeutic maintenance treatment period,anemia,albumin ≤35g/l,and infection),a non-conditional two-class Logistic regression multivariate analysis suggested that the chemotherapy maintenance treatment period is the degree of liver function injury after chemotherapy Potential impact factors(P=0.086).Anemia(P=0.030,OR=2.979,95% CI: 1.108 to 8.008),albumin ≤35 g/l(P=0.009,OR=1.017,95% CI: 1.004 to 1.029),infection(P=0.028,OR =3.365,95%CI:1.143~9.908)is an independent influencing factor of liver injury after chemotherapy.Conclusions: 1.The incidence of hepatic injury in children with ALL chemotherapy is high,and the form of liver injury is mainly mild liver damage without severe liver damage.2.The occurrence of liver injury in different degrees is related to the chemotherapy stage,hemoglobin levels,albumin,and infection factors.3.Anemia,albumin ≤35g/l,infection is an independent influencing factor of liver function injury after chemotherapy,reducing the incidence of these factors as much as possible,and giving appropriate supportive treatment will likely reduce the incidence of liver damage Improve the patient’s prognosis. |
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