尽管化疗引起的肠粘膜炎是血流感染 (BSI) 的主要危险因素，但尚无研究调查粘膜炎的严重程度来预测急性白血病治疗期间发烧时出现的 BSI。这项研究通过测量瓜氨酸（反映肠上皮细胞损失）、再生胰岛衍生蛋白 3α（REG3α，一种肠道抗菌肽）的血浆水平，前瞻性评估了 85 名急性白血病儿童的肠粘膜炎严重程度，这些儿童代表 242 次发热发作（122 次并发中性粒细胞减少症） ）和 CCL20（一种粘膜免疫调节趋化因子）以及发烧时的一般中性粒细胞趋化剂 CXCL1 和 CXCL8。 14% 的发热发作和 20% 的中性粒细胞减少性发热发作均记录有 BSI。在年龄、性别、诊断和中性粒细胞计数调整分析中，瓜氨酸水平降低和 REG3α 和 CCL20 水平升高与 BSI 几率增加独立相关（OR = 1.6、1.5 和 1.7 每减半/加倍，所有 p< 0.05 ）。此外，较高的 CXCL1 和 CXCL8 水平会增加 BSI 的几率（每倍增 OR = 1.8 和 1.7，所有 p< 0.0001）。与 C 反应蛋白和降钙素原相比，所有三种趋化因子的诊断准确性均有所提高。这些发现强调了肠道完整性受损作为 BSI 主要危险因素的重要性，并表明监测粘膜炎严重程度的客观标记可能有助于预测发烧时的 BSI。© 2023。作者。

Despite chemotherapy-induced intestinal mucositis being a main risk factor for blood stream infections (BSIs), no studies have investigated mucositis severity to predict BSI at fever onset during acute leukemia treatment. This study prospectively evaluated intestinal mucositis severity in 85 children with acute leukemia, representing 242 febrile episodes (122 with concurrent neutropenia) by measuring plasma levels of citrulline (reflecting enterocyte loss), regenerating islet-derived-protein 3α (REG3α, an intestinal antimicrobial peptide) and CCL20 (a mucosal immune regulatory chemokine) along with the general neutrophil chemo-attractants CXCL1 and CXCL8 at fever onset. BSI was documented in 14% of all febrile episodes and in 20% of the neutropenic febrile episodes. In age-, sex-, diagnosis- and neutrophil count-adjusted analyses, decreasing citrulline levels and increasing REG3α and CCL20 levels were independently associated with increased odds of BSI (OR = 1.6, 1.5 and 1.7 per halving/doubling, all p < 0.05). Additionally, higher CXCL1 and CXCL8 levels increased the odds of BSI (OR = 1.8 and 1.7 per doubling, all p < 0.0001). All three chemokines showed improved diagnostic accuracy compared to C-reactive protein and procalcitonin. These findings underline the importance of disrupted intestinal integrity as a main risk factor for BSI and suggest that objective markers for monitoring mucositis severity may help predicting BSI at fever onset.© 2023. The Author(s).