| Objective:By sorting out and analyzing the clinical case data of children with newly diagnosed leukemia in Yunnan,we can understand the characteristics and regularity of childhood leukemia in Yunnan,so as to provide a reference for further guidance and prevention of childhood leukemia.Methods:To retrospectively collect,sort out,and analyze the clinical case data of 1126 children with newly diagnosed leukemia admitted to Kunming Children’s Hospital from 2014 to 2019.The content of the analysis mainly includes the children’s clinical diagnostic classification(MICM)and risk classification;Demographic characteristics;birth information;clinical test indicators and other data.Use SPSS 23.0 software to analyze the collected data.Results:Leukemia composition:Acute leukemia(95.65%)is the main type of leukemia,and the majority are children with ALL and AML,accounting for 70.96%and 23.71%of the study subjects,respectively.Children with chronic leukemia and CML only account for the study subjects 2.04%of AML;morphological immunological classification:M3 and M5 are the most common in children with AML,accounting for 22.85%and 19.85%respectively;the immunological classification of ALL children is mainly expressed by the B line(85.81%);children with AHL are AML+T-ALL expression is the main(81.82%);850 cases of children were tested for fusion gene,410 cases were positive(48.24%),the positive rate of TEL-AML 1 gene was the highest(10.59%),and the positive rate of BCR-ABL gene was the second(9.41%);risk classification:779 children underwent risk classification,242 cases of low-risk type(31.07%),389 cases(49.94%)of medium-risk type,and 148 cases of high-risk type(19.00%);gender distribution:Male children(57.55%)have the most common incidence,with a male-to-female ratio of 1.36:1;age distribution:the youngest child is 9 days old,the oldest child is 15 years old;The proportion of children aged 1 to 4 years is the highest(43.69%);Seasonal distribution:most children are born in winter;most children have onset time in summer;ethnic distribution:848 children with Han ethnic group(75.31%),278 children from ethnic minorities(24.69%),82 children from Yi ethnicity(29.50%)among ethnic minority children,followed by 34 children from Hani ethnicity(12.23%);regional distribution:Yunnan Province There were 1,055 children(93.69%),mainly from Kunming City,203 cases(19.24%),Qujing City,164 cases(15.55%),Honghe Prefecture,118 cases(11.18%),and 71 children(6.31%)from outside Yunnan Province.Mainly from Guizhou area(77.47%),Sichuan area(7.04%);blood type distribution:type A(34.87%)>type O(33.06%)>type B(24.64%)>type AB(7.43%);parity:First birth(54.02%)and second birth(36.34%)are the main ones.The proportion of third births and above is relatively small(9.64%);Pregnancy:Among 953 cases recorded,926 full-term babies(97.17%)),27 cases of premature infants(2.83%);mode of delivery:1120 cases of records,846 cases(75.54%)of normal infants,274 cases(24.46%)of cesarean section infants;birth weight:birth weight range of 1.29-7.00kg,The median weight was 3kg.Among 793 cases,675 cases(85.12%)were normal birth weights,and 118 cases(14.88%)were abnormal birth weights.Feeding history:Among 1100 cases,795 cases(72.27%)were breastfeeding,artificial feeding 147 cases(13.36%),mixed feeding 15 8 cases(14.36%);past history:840 healthy cases(74.60%),286 abnormal cases(25.40%),of which 204 cases(18.12%)were mainly common sense and diarrhea;allergic history:1120 cases In the record,52 cases(4.64%)had a history of allergies,mainly penicillin allergy and cephalosporin allergy;trauma history:Among 1008 cases,52 cases(5.16%)had a history of trauma surgery,mainly including hernia surgery,limb and joint injury Surgery;history of vaccination:out of 1120 cases,21 cases(1.88%)were not vaccinated on time;history of close relatives:11 cases of close relatives(0.98%)among 1124 cases;history of family hereditary and infectious diseases:1068 cases Among them,88 cases were abnormal(8.24%),mainly liver disease(31.82%),tuberculosis(14.77%),blood system disease(14.77%);blood routine:white blood cell count range(0.55-792.33)×10^9/L,287 cases(25.49%)were normal,839 cases(74.51%)were abnormal;the hemoglobin content range(3.28-164)g/L,113 cases(10.04%)were normal,1013 cases(89.96%)were anemia,and the platelet count range(2-1268)×10^9/L,average 87.79×10^9/L,232 normal cases(20.60%),894 abnormal cases(79.40%);red blood cell count range(0.97-40.5)×10^9/L,The average value was 3.10×10^9/L,285 cases were normal(25.31%),841 cases were abnormal(74.69%);the detection rate of naive cells(70.60%),including ALL(65.71%),AML(82.40%),CML(73.91%),AHL(90.91%);clinical symptoms:727 children(64.56%)with fever,including 518 children(64.83%)with ALL,176 children(65.92%)with AML,and 9 children with CML(39.13%),7 children with AHL(63.64%);455 children with bleeding(40.41%),including 279 children(34.92%)with ALL,152 children(56.93%)with AML,4 children with CML Cases(17.39%)4 children(36.36%)with AHL;842 children(74.78%)with infiltrating symptoms,including 630 children(78.85%)with ALL,170 children(63.67%)with AML,and children with CML 18 cases(78.26%),8 children with AHL(72.73%);way of discharge:883 children(78.42%)received treatment,235 children(20.87%)gave up treatment,and 8 children died(0.71%);children with ALL received the highest rate of treatment(84.11%),and children with CML had the highest rate of abandoning treatment(30.43%);incidence trend:initial onset The number of cases rose from 118 in 2014 to 244 in 2019,with an average annual growth rate of 12.87%;the annual growth rate of female children(14.34%)was higher than that of male children(11.85%);children with ethnic minorities(22.76%)The annual growth rate is higher than that of Han children(9.08%);the treatment abandonment rate dropped from 22.03%in 2014 to 13.52%in 2019.Conclusion and suggestion:Conclusion 1:This study shows that there may be an upward trend in the number of cases of childhood leukemia in Yunnan from 2014 to 2019,the situation of childhood leukemia prevention and treatment is severe,and the demand for medical services will continue to increase.Suggest:(1)The health administration department needs to optimize the allocation of medical and health resources based on the regional distribution characteristics,especially in the eastern region where the distribution of children is relatively concentrated.(2)Medical institutions should actively adjust the scale of hematology department and related departments,software and hardware facilities,and talent training according to the trend of disease.(3)As a designated treatment unit for childhood leukemia,the Department of Hematology in this hospital needs to further strengthen discipline construction,accelerate personnel training,expand the scale of the department,actively develop new businesses and new technologies,and continue to meet the needs of the medical service market.Conclusion 2:The study found that the disease severity and prognosis of children affected by the Yi,Bai,Hani,Dai,Lisu,and Wa ethnic groups are poor.Suggest:(1)It is necessary to further study the etiology and risk factors of such ethnic groups to control the incidence of diseases.(2)Pay attention to improving the service capacity and level of primary medical and health institutions,do a good job in the preliminary screening of diseases,promote early detection,early diagnosis and early treatment of leukemia patients,and increase the cure rate.(3)Promote higher-level hospitals to strengthen cooperation in the construction of medical consortia,and improve the accessibility of high-quality resources and the overall efficiency of medical services through the hierarchical diagnosis and treatment model of primary diagnosis,two-way referral,emergency and slow treatment,and upper and lower linkages.Objectives:Through the analysis of the hospitalization expenses of newly treated children with leukemia,assess whether the structure of the hospitalization expenses is reasonable,predict the change trend of the hospitalization expenses,analyze the factors affecting the hospitalization expenses,and propose corresponding suggestions or measures to reduce the economic burden of the children and their families.Methods:Collect and sort out the demographic information and cost information of 1093 children with newly-treated leukemia in Kunming Children’s Hospital from January 1,2014 to December 31,2019,and use median and quartile descriptions for their hospitalization costs.Non-parametric test and multiple linear regression analysis were performed on the factors affecting hospitalization expenses.Results:(1)In the first hospitalization cost,the hospitalization cost of male children(36867.74 yuan)is higher than that of female children(35924.41 yuan);the hospitalization cost gradually increases with age;the hospitalization cost of Han children(36932.57 yuan)is higher Children with ethnic minorities(35629.70 yuan);children with acute leukemia(37622.80 yuan)have higher hospitalization expenses than children with chronic leukemia(15970.96 yuan);the more severe the pathological stage,the higher the hospitalization costs;the insured children(44320.90 yuan)The hospitalization cost of children is higher than that of self-funded children(32056.96 yuan);the hospitalization-cost increases with the lengthening of the hospitalization;(2)The proportion of the first hospitalization of middle and high-risk children is getting higher and higher,with an average annual growth rate of 17.23%;(3))The first per capita hospitalization cost is 37067.58 yuan,the per capita hospitalization days is 28.10 days,and the average daily hospitalization cost is 1324.38 yuan;(4)The fixed base ratios of the per capita costs from 2015 to 2019 are 106.52%,109.33%,104.90%,110.81%,115.55%;(5)Western medicine fees(42.50%),laboratory testing fees(21.35%),blood transfusion fees(11.65%)accounted for the top three in hospitalization expenses;(6)Western medicine fees,treatment fees and nursing expenses showed an increase in the proportions Trends;(7)The hospitalization expenses of children with different ages,leukemia types,pathological stages,medical payment methods,and length of hospitalization were significantly different(P<0.05).(8)Pathological staging,medical payment methods,leukemia classification,length of hospitalization,and age are the main factors affecting hospitalization expenses.Conclusion:(1)The burden of disease is increasing year by year;(2)The proportion of drugs is increasing year by year;(3)The importance of health education knowledge needs to be strengthened,and the awareness of early disease prevention needs to be improved.Suggest:(1)Government departments:accelerate the national centralized procurement of drugs,reduce drug prices,and reduce the burden on children’s families;improve medical insurance policies,increase the proportion of reimbursements for children with leukemia,and provide protection for the treatment of children;strengthen public health knowledge to control and reduce Exposure of risk factors can reduce morbidity;broaden the rescue channels for children and reduce the burden on their families.(2)Medical institutions:implement clinical pathways,standardize diagnosis and treatment procedures,and control costs;strengthen management and control of nosocomial infections,shorten hospital stays,and control costs. |
