Abstract: Objective　To analyze the incidence of 6-mercaptopurine（6MP）-related hypoglycemia in childhood acute lymphoblastic leukemia（ALL）during a short course of therapy. Methods　Forty-eight children with ALL during treatment with the CAM regimen（containing cyclophosphamide，cytarabine and 6MP）were consecutively enrolled from Jan. 2020 to May 2021（6MP group），and 21 children during treatment with the AML consolidation regimen 1，which did not contain 6MP，were also enrolled as controls（no-6MP group）. Incidence of hypoglycemia and the related clinical data during the treatment were collected and the risk factors for developing hypoglycemia were analyzed. Results　No hypoglycemia was observed in the no-6MP group，and the incidence of hypoglycemia was 39.6% in the 6MP group，of which only 10.5% had hypoglycemic symptoms；the median age of the hypoglycemia subgroup was significantly lower than that of the no-hypoglycemia subgroup（3.6 and 6.0 years old，P<0.001），and the median values of glutamic oxalate aminotransferase were also higher in the hypoglycemia subgroup（123.3 U/L and 87.4 U/L，P=0.040），but there was no statistical difference in the median values of total bilirubin（16.8 μmol/L and 15.0 μmol/L，P=0.052）. Logistic regression analysis showed that younger age and liver damage were the risk factors for developing hypoglycemia. Conclusion　Hypoglycemia is also common in children receiving short-term exposure to 6-MP. Younger age with liver function impairment is the risk factor for developing hypoglycemia.Most hypoglycemic symptoms are insidious and clinically overlooked. Therefore，sufficient attention should be paid to them to avoid hypoglycemia in ALL children during 6MP treatment， and thus avoid negative impact on children’s brain development.

Key words: hypoglycemia, 6-mercaptopurine, child, acute lymphoblastic leukemia

摘要： 目的　分析儿童急性淋巴细胞白血病（ALL）短疗程6-巯基嘌呤（6MP）低血糖发生情况及其危险因素。方法　选取中山大学附属第一医院儿科2020年1月至2021年5月连续纳入含环磷酰胺、阿糖胞苷和6MP（CAM）方案治疗期间ALL儿童48例（6MP 组），另纳入不含6MP的急性髓系白血病巩固方案1治疗期间的21例作为对照组（无6MP组），收集两组治疗期间低血糖发生情况及相关临床资料，分析低血糖发生的危险因素。结果　无6MP组未观察到低血糖，6MP组低血糖发生率39.6%，其中仅10.5%有低血糖症状；低血糖亚组的年龄明显低于无低血糖亚组（中位数3.6和6.0岁，P<0.001），丙氨酸氨基转移酶也较高（中位数123.3 U/L和87.4 U/L，P=0.040），总胆红素差异无统计学意义（16.8 μmol/L和15.0 μmol/L，P=0.052）。Logistic回归分析显示，低龄、肝损伤是低血糖发生的危险因素。结论　中国儿童接受短疗程6MP同样低血糖发生率高；低龄伴肝损伤是高危因素；多数低血糖症状隐匿而被临床忽视。应重视ALL患儿6MP治疗中的低血糖，以避免对儿童脑发育造成不良影响。

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