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在患有ALL的儿童中解开德克萨米他诱导的神经行为和睡眠问题:哪些决定因素是重要的?
Annelienke M van Hulst1, Martha A Grootenhuis1, Emma J Verwaaijen1
1Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands.
JCO precision oncology
|June 21, 2023
概括
育儿压力对接受急性淋巴细胞白血病 (ALL) 德克萨米他治疗的儿童的神经行为和睡眠问题作出了重大贡献. 解决父母的压力可能有助于减轻这些常见的副作用在儿科ALL患者.
科学领域:
- 儿科瘤学 儿科瘤学
- 临床药理学 临床药理学
- 儿童心理学 儿童心理学
背景情况:
- 德克萨米他是治疗儿科急性淋巴细胞白血病 (ALL) 的关键皮质类固醇.
- 然而,使用德克萨米他与儿童显著的神经行为和睡眠障碍有关.
- 在这些不良反应的发生和严重程度上存在很高的患者间变异性.
研究的目的:
- 确定家长报告的神经行为和睡眠问题的关键决定因素,在儿科ALL患者中诱导德甲.
- 调查患者/家长人口统计,疾病/治疗因素,育儿压力,德克萨米他的药物动力学和遗传变异的影响.
主要方法:
- 一项前性研究,涉及105名在维持治疗期间的儿科ALL患者.
- 父母报告的神经行为和睡眠问题使用验证的问卷 (优点和困难问卷,儿童睡眠障碍量表) 进行评估.
- 使用多变量逻辑回归分析来确定重要的决定因素,包括育儿压力,药理动力学和遗传标记 (rs41423247,rs4918).
主要成果:
- 临床相关的神经行为和睡眠问题分别在67%和59%的患者报告.
- 父母压力成为神经行为 (OR,1.16) 和睡眠问题 (OR,1.06) 的重要决定因素.
- 在使用德克萨米他之前,父母的较高压力与儿童睡眠问题增加相关 (OR,1.16).
结论:
- 父母压力,而不是药理动力学或遗传因素,是儿科ALL中德克萨米他诱导的神经行为和睡眠问题的重要决定因素.
- 育儿压力是旨在减少这些不利影响的干预措施的潜在可修改目标.
- 进一步的研究应该探索减轻育儿压力的策略,以改善ALL儿童的治疗结果和生活质量.
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