儿童急性淋巴细胞白血病化疗前后细胞免疫的变化及与人巨细胞病毒感染的关系

The Change of Cellular Immunity During Chemotherapy on Children with Acute Lymphoblastic Leukemia and the Relationship with Human Cytomegalovirus Infection

目的探讨儿童急性淋巴细胞白血病(ALL)化疗前后细胞免疫的变化及与人巨细胞病毒(HCMV)感染的关系。方法103例接受化疗的ALL患儿设为ALL组,34例健康儿童设为对照组,流式细胞术检测对照组、ALL组初治时、化疗结束时、化疗后3个月T细胞亚群。化疗结束时采用PCR检测HCMV病毒,并根据检测结果分为感染组和未感染组,对比分析两组T细胞亚群差异,多因素Logistic回归分析HCMV感染的影响因素。结果 ALL组(初治时)T细胞亚群CD3^+、CD4^+、CD8^+、CD4^+/CD8^+均低于对照组,差异有统计学意义(P<0.05);ALL组化疗前后CD3^+、CD4^+、CD4^+/CD8^+表现出先降低后升高的趋势,差异具有统计学意义(P<0.05);化疗结束时共18例患者HCMV病毒检测为阳性,感染组化疗结束时CD3^+、CD4^+、CD4^+/CD8^+低于未感染组,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,疾病危险度是ALL患儿HCMV感染的危险因素(AOR=1.543,95%CI:1.213~1.809,P=0.028),而CD3^+、CD4^+、CD4^+/CD8^+、最低PLT是HCMV感染的保护因素。结论 ALL自身以及化疗后细胞免疫功能降低,增加了HCMV感染风险,细胞免疫功能下降与HCMV感染可能互为因果。

Objective To explore the change of cellular immunity during chemotherapy on children with acute lymphoblasticleukemia（ALL） and the relationship with human cytomegalovirus（HCMV） infection. Methods We enrolled 103 ALL children with chemotherapy as ALL group,and 34 cases healthy children as control group. T cell subgroup at the start of chemotherapy,the completion and 3 months later was detected by flow cytometry. The HCMV was detected by PCR at the end of chemotherapy. ALL group was further divided into the HCMVinfected and uninfected group. T cell subgroup between two groups was compared and the influence factors of HCMV infection wereanalyzed withmultivariate Logistic regression analysis. Results T cell subsets CD3^＋,CD4^＋,CD8^＋and CD4^＋/CD8^＋in ALL group at the beginning of chemo were lower than that of the control group,the differencesw ere statistically significant（P〈0. 05）. At the end of chemotherapy,a total of 18 patients were detected with HCMV infection. CD3^＋,CD4^＋and CD4^＋/CD8^＋in infected group were lower than uninfected group,the difference was statistically significant（P〈0. 05）.Multivariate Logistic regression analysis show ed that disease risk was the risk factors（ AOR = 1. 543,95% CI：1. 213- 1. 809,P = 0. 028）,while the CD3^＋,CD4^＋,CD4^＋/CD8^＋,minimum PLT were the protection factorsof HCMV infection. Conclusion Reduced cellular immune function in ALL and after chemotherapy may increase the risks for HCMV infection. The decline in cellular immune function may be causal to HCMV infection.