Construction of sentinel factors for cognitive impairment in children with leukemia based on the multifactorial model of cancer-related cognitive impairment and analysis of influencing factors

Zeng Yan; Mo Lin; Cai Qian; He Li; Zhang Xian; Zhang Meng; Guo Xiaoli; Yao Juan

doi:10.13406/j.cnki.cyxb.004061

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Construction of sentinel factors for cognitive impairment in children with leukemia based on the multifactorial model of cancer-related cognitive impairment and analysis of influencing factors

Precision medicine in cancer and translational studies | 更新时间：2026-04-15

- Construction of sentinel factors for cognitive impairment in children with leukemia based on the multifactorial model of cancer-related cognitive impairment and analysis of influencing factors
- Journal of Chongqing Medical University Vol. 51, Issue 4, Pages: 500-509(2026)
- 作者机构：
  
  1.重庆医科大学附属儿童医院门诊部/儿童少年健康与疾病国家临床医学研究中心/儿童发育疾病研究教育部重点实验室/ 儿童神经发育与认知障碍重庆市重点实验室，重庆 400014
  2.中南大学湘雅三医院护理部，长沙 410000
  3.电子科技大学医学院附属妇女儿童医院/成都市妇女儿童中心医院/儿童血液及肿瘤内科，成都 611731
  4.重庆医科大学附属儿童医院血液肿瘤科/儿童少年健康与疾病国家临床医学研究中心/ 儿童发育疾病研究教育部重点实验室/儿童神经发育与认知障碍重庆市重点实验室，重庆 400014
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.004061
  CLC： R733.7
- Received：03 November 2025，
  
  Revised：2026-01-16，
  
  Accepted：19 January 2026，
  
  Published：28 April 2026
- 稿件说明：
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曾燕，莫霖，蔡骞，等.基于MMCRCI框架的白血病患儿认知障碍前哨因子指标构建及影响因素分析[J].重庆医科大学学报，2026，51（4）：500-509.

Zeng Yan,Mo Lin,Cai Qian,et al.Construction of sentinel factors for cognitive impairment in children with leukemia based on the multifactorial model of cancer-related cognitive impairment and analysis of influencing factors[J].Journal of Chongqing Medical University,2026,51(4):500-509.
曾燕，莫霖，蔡骞，等.基于MMCRCI框架的白血病患儿认知障碍前哨因子指标构建及影响因素分析[J].重庆医科大学学报，2026，51（4）：500-509. DOI： 10.13406/j.cnki.cyxb.004061.

Zeng Yan,Mo Lin,Cai Qian,et al.Construction of sentinel factors for cognitive impairment in children with leukemia based on the multifactorial model of cancer-related cognitive impairment and analysis of influencing factors[J].Journal of Chongqing Medical University,2026,51(4):500-509. DOI： 10.13406/j.cnki.cyxb.004061.

摘要

目的

基于癌症相关认知障碍多因子模型，通过循证方法构建白血病患儿癌症相关认知障碍前哨因子指标体系，并分析其影响因素。

方法

检索国内外相关循证数据库中有关癌症相关认知障碍的文献，检索时限为2000年1月1日至2025年8月1日。对纳入文献进行质量评价并对提取的证据进行质量分级和确定推荐级别。采用横断面调查法，纳入2024年11月至2025年8月期间来自重庆医科大学附属儿童医院、成都市妇女儿童中心医院、中南大学湘雅三家医院的105例白血病患儿。通过年龄与发育进程问卷、儿童睡眠习惯问卷及Spence学龄前儿童焦虑量表中文修订版评估患儿，根据构建的指标体系收集临床指标数据，并分析前哨因子的影响因素。

结果

共纳入9篇文献，其中系统评价9篇，汇总了患者层面、生物学层面、治疗层面及共存症状4个方面的13条最佳证据。白血病患儿认知障碍相关的前哨因子包括：睡眠障碍、焦虑状态、抑郁状态、血清白细胞介素6（interleukin-6，IL-6）、白细胞介素8（interleukin-8，IL-8）、白细胞介素10（interleukin-10，IL-10）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、CD4

/CD8

淋巴细胞比值、甲氨蝶呤解救期血药浓度以及头颅影像检查结果。影响因素分析显示，住院期间电子产品使用时长、主要治疗方式、家庭情感支持及教养方式是白血病患儿认知障碍前哨因子的影响因素（

0.05）。

结论

通过循证的方法初步构建了白血病患儿癌症相关认知障碍前哨因子指标体系，前哨因子受到生理、医疗与家庭多重因素的影响，未来可考虑建立多学科联合诊疗模式，多维度评估，以期有效改善白血病患儿的长期认知预后与生活质量。

Abstract

Objective

To establish a sentinel factor indicator system for cancer-related cognitive impairment in children with leukemia using the evidence-based method based on the multifactorial model of cancer-related cognitive impairment，and to analyze related its influencing factors.

Methods

Evidence-based databases in China and globally were searched for articles on cancer-related cognitive impairment published from January 1，2000 to August 1，2025. Quality assessment was performed for the articles included，and the evidence extracted was graded and recommended. A cross-sectional survey was conducted among 105 children with leukemia who were treated in Children’s Hospital of Chongqing Medical University，Chengdu Women’s and Children’s Central Hospital，and The Third Xiangya Hospital of Central South University from November 2024 to August 2025. The children were assessed using Ages and Stages Questionnaire，Children’s Sleep Habits Questionnaire，and Spence Preschool Anxiety Scale （revised Chinese version）. Clinical indices were collected based on the indicator system，and the influencing factors for sentinel factors were analyzed.

Results

A total of 9 articles were included，including 9 systematic reviews，which summarized 13 best evidence items from the four aspects of patients，biology，treatment，and coexisting symptoms. The sentinel factors associated with cognitive impairment in children with leukemia included sleep disorders，anxiety，depressive state，serum interleukin-6（IL-6），interleukin-8（IL-8），interleukin-10（IL-10），tumor necrosis factor-α（TNF-α），CD4

/CD8

lymphocyte ratio，blood concentration of methotrexate rescue，and cranial imaging findings. The analysis of influencing factors showed that duration of use of electronic devices during hospitalization，primary treatment modality，family emotional support，and parenting style were influencing factors for sentinel factors for cognitive impairment in children with leukemia（

0.05）.

Conclusion

A preliminary sentinel factor indicator system is established for cancer-related cognitive impairment in children with leukemia using the evidence-based method. Sentinel factors are influenced by multiple physiological，medical，and family factors，and a multidisciplinary diagnostic and therapeutic mode should be established in the future to implement multidimensional assessment，so as to effectively improve the long-term cognitive prognosis and quality of life of children with leukemia.

关键词

Keywords

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Related Institution

Department of Hematology and Oncology，Children’s Hospital of Chongqing Medical University，National Clinical Research Center for Children and Adolescents' Health and Diseases，Ministry of Education Key Laboratory of Child Development and Disorders， Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders

Department of Pediatric Hematology and Oncology，Chengdu Women’s and Children’s Central Hospital， School of Medicine，University of Electronic Science and Technology of China

School of Nursing，Chongqing Medical University

Outpatient Department，Children’s Hospital of Chongqing Medical University，National Clinical Research Center for Children and Adolescents' Health and Diseases，Ministry of Education Key Laboratory of Child Development and Disorders，Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders

National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders/Outpatient Department， Children’s Hospital of Chongqing Medical University

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