急性淋巴细胞白血病并EB病毒感染的临床分析

Clinical Analysis of Acute Lymphocytic Leukemia Complicated with Epstein-Barr Virus Infection in Children

目的探讨EB病毒（EBV）在急性淋巴细胞白血病（ALL）儿童中的感染及其临床意义。方法采用荧光定量聚合酶链反应（FQ-PCR）技术检测EBV DNA,ELISA法检测EB病毒衣壳抗原IgM抗体（EBV-CA-IgM）,共检测47例。其中新发45例,复发2例;年龄0~14岁[（8.06±3.71）岁]。另取14例健康儿童作为健康对照组。男9例,女5例;年龄2~10岁[（7.24±2.54）岁]。结合临床表现、诱导治疗骨髓完全缓解（CR）率、形态学CR状态下的微小残留病（MRD）、复发率及无事件生存（EFS）率等分析ALL患儿中EBV感染情况及其临床意义。结果 47例ALL患儿中检出EBV感染15例（31.9%）,其中11例（23.40%）检出EBV DNA,EBV DNA水平为（3.28±5.95）×108copy.L-1;14例健康对照组外周血未检测到EBV DNA及EBV-CA-IgM。ALL中EBV感染组与非EBV感染组白细胞数分别为（78.00±58.38）×109L-1、（27.46±60.10）×109L-1（t=2.70,P=0.01）,诱导治疗CR率分别为46.7%、87.5%（P〈0.01）,MRD〉10-3分别为90.0%、26.1%（P〈0.01）,复发率分别为53.8%、13.8%（P〈0.01）,EFS率分别为23.1%、82.8%（P〈0.01）。结论 ALL并EBV感染具有高白细胞数、低诱导治疗CR率、高复发率、低EFS率,提示EBV感染可能参与儿童ALL的发生发展过程,亟待改善EBV感染ALL的治疗方法。

Objective To study the Epstein-Barr virus（EBV） infection in children with acute lymphocytic leukemia（ALL） and to explore its clinical significance.Methods Serum EBV-CA-IgM and EBV DNA in peripheral blood mononuclear cells in 47 cases with ALL and 14 healthy children were detected by enzyme linked immunosorbent assay and fluorescence quantitative-polymerase chain reaction（FQ-PCR）.In 47 ALL children,new diagnosed ALL were in for 45 cases,relapsed ALL were 2 cases,and their ages were 0-14 years old.With mean age（8.06±3.71） years old;while in 14 healthy children,9 cases were male,5 were female;ages between 2-10 years old,with mean age（7.24±2.54） years old.The EBV infection in children with ALL and its clinical significance were analyzed according to the clinical manifestations,complete remission（CR） rate after induction chemotherapy,determination of minimal residual disease（MRD） after CR,relapse rate and effect free survival（EFS） rate.Results EBV infection was detected in 15 cases（31.90%） of 47 ALL children;11 cases（23.40%） were detected EBV DNA,and the quantity of EBV DNA was（3.28±5.95）×108 copy·L-1;EBV DNA and EBV-CA-IgM were not detected in healthy control group.Childhood ALL with EBV infections had a significantly higher incidence of peripheral leukocytosis[（78.00±58.38）×109 L-1 vs（27.46±60.10）×109 L-1,t=2.70,P=0.01].In ALL,CR rate after induction chemotherapy in ALL with EBV infection was significantly lower than that in children without EBV infection（46.7% vs 87.5%,P0.01）.The differences of MRD 10-3（90.0% vs 26.1%）,relapse rate（53.8% vs 13.8%）,and EFS rate（23.1% vs 82.8%） were statistically significant between EBV infection and non EBV infection individuals（Pa0.01）.Conclusions Childhood ALL with EBV infection had higher incidence of peripheral leukocytosis,with low CR rate,high MRD,high relapse rate and low EFS rate.EBV infection might be associated with childhood ALL.This suggested that a strategy of late monitoring and salvage therapy will improve outcome.