Hiperinflamacija uspešno otklonjena deksametazonom kod pedijatrijskih bolesnika obolelih od hematoloških maligniteta

  • Marija Ćazić University Children’s Hospital, Belgrade, Serbia
  • Nada Krstovski University Children’s Hospital, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Jelena Lazić University Children’s Hospital, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Predrag Rodić University Children’s Hospital, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Goran Milošević University Children’s Hospital, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Dejan Škorić University Children’s Hospital, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Srdja Janković University Children’s Hospital, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP241124034C
Ključne reči: adolescenti;, deca;, dijagnoza, diferencijalna;, lečenje lekovima;, neutropenija, febrilna;, zapaljenje;, limfohistiocitoza, hemofagocitna;, lečenje, ishod

Sažetak


Uvod/Cilj. Hiperinflamatorni sindromi su relativno retka pojava, ali mogu ugroziti život dece obolele od maligniteta. Hemofagocitna limfohistiocitoza (HLH) je najpoznatija od nekoliko takvih hiperinflamatornih sindroma koji dele ključni aspekt patogeneze – „citokinsku oluju“. Međutim, stanja koja podsećaju na HLH, ali ne ispunjavaju u potpunosti njene dijagnostičke kriterijume, nisu retka i često predstavljaju dijagnostički izazov. Cilj rada bio je da se ispitaju kliničke karakteristike, tok bolesti i odgovor na lečenje deksametazonom kod dece koja imaju hematološke malignitete i hiperinflamaciju. Metode. Retrospektivnom opservacionom studijom analizirane su istorije bolesti jedanaestoro dece (četiri devojčice i sedam dečaka; medijana uzrasta 10,8 godina, raspon 3,1–16,3 godine) ispitivane zbog potencijalne hiperinflamacije tokom lečenja od hematološke maligne bolesti na Univerzitetskoj dečjoj klinici u Beogradu, Srbija, od januara 2023. do jula 2024. godine. Prikupljeni su relevantni klinički i laboratorijski parametri (koncentracija triglicerida u serumu izmerena je kod desetoro dece), kao i podaci o potencijalnim okidačima, lečenju deksametazonom i ishodu lečenja. Rezultati. Sva deca bila su febrilna. Bicitopenija/pancitopenija je zabeležena kod šestoro (54,5%), a splenomegalija kod dvoje (18,2%) dece. Aspiracija koštane srži obavljena je kod devetoro dece, a hemofagocitoza nije uočena. Koncentracija triglicerida u serumu bila je povišena kod jednog (10,0%) deteta. Nivoi fibrinogena bili su iznad 1,5 g/L kod sve dece, a nivoi feritina nadmašili su 500 μg/L kod desetoro (90,1%) dece. Kod dvoje (18,2%) dece nivo solubilnog receptora za interleukin-2 (sIL-2R) bio je iznad 2 400 IU/mL (njegova medijana iznosila je 1 041 IU/mL, raspon 396–9 069 IU/mL, a interkvartilni opseg 1 012 IU/mL). Samo jedno dete ispunilo je pet od osam HLH-2004 kriterijuma. Potencijalni virusni, bakterijski ili gljivični okidač identifikovan je kod osmoro dece. Osmoro dece lečeno je deksametazonom, uz brzo okončanje naleta hiperinflamacije. Zaključak. U dijagnostičkoj obradi febrilnog deteta koje ima hematološki malignitet uvek bi trebalo razmotriti zapaljensko stanje koje povoljno reaguje na lečenje glukokortikoidima.

 

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Objavljeno
2025/06/27
Broj časopisa
Vol. 82 Br. 06 (2025): Vojnosanitetski pregled
Rubrika
Originalni članak