合并EB病毒感染的儿童急性淋巴细胞白血病临床特征及预后分析

Clinical characteristics and prognosis of childhood acute lymphoblastic leukemia complicated with EB virus infection

目的探讨合并EB病毒(EBV)感染的儿童急性淋巴细胞白血病(ALL)临床特征及预后。方法收集2015年1月至2019年1月于华中科技大学同济医学院附属同济医院诊断的196例ALL患儿外周血EBV抗体及外周血单个核细胞EBV-DNA检测结果,根据检测结果将196例ALL患儿分成EBV感染组及非EBV感染组。比较两组患儿肝脾大、染色体、外周血常规、免疫分型、临床危险度、化疗过程中继发感染、化疗后第46天微小残留病(MRD)、染色体核型等情况及预后。随访至2019年4月30日。结果196例白血病患儿中EBV感染143例,感染率72.96%(143/196),EBV感染患儿外周血单个核细胞EBV-DNA水平[中位数(P25,P75)]为3.7×103拷贝/L(1.6×103拷贝/L,8.8×103拷贝/L)。EBV感染组患儿肝脾大(肋缘下≥5 cm)发生率高于非EVB感染组[14.69%(21/143)比3.77%(2/53),χ^2=4.45,P=0.035],EBV感染组初诊白细胞计数、异常染色体核型发生率与非EBV感染组比较,差异均无统计学意义(均P>0.05)。EBV感染组患儿治疗过程中继发感染率高于非EBV感染组[41.96%(60/143)比24.53%(13/53),χ^2=5.03,P=0.025]。EBV感染组患儿化疗后第46天完全缓解率低于非EBV感染组[80.42%(115/143)比98.11%(52/53),χ^2=9.60,P=0.020],复发率高于非EBV感染组[11.89%(17/143)比1.89%(1/53),χ^2=4.64,P=0.031];两组免疫分型及临床危险度构成比差异均有统计学意义(均P<0.05)。结论合并EBV感染的ALL患儿肝脾大明显,化疗过程中继发感染率高,缓解率低,复发率高,预后不良。EBV感染可能与ALL患儿免疫分型、临床危险度有关,与异常染色体核型无关。

Objective To explore the clinical features and prognosis of childhood acute lymphoblastic leukemia(ALL)complicated with EB virus(EBV)infection.Methods The results of detection of EBV antibody and EBV-DNA in peripheral blood mononuclear cells of 196 children with ALL diagnosed in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2015 to January 2019 were collected.According to the results,196 children with ALL were divided into EBV infection group and non-EBV infection group.The hepatomegaly and splenomegaly,chromosome,peripheral blood routine,immunophenotyping,clinical risk,secondary infection during chemotherapy,minimal residual disease(MRD)of day 46 after chemotherapy,karyotype,and prognosis were compared between the two groups.The children were followed up until April 30,2019.Results Among 196 children with ALL,EBV infection rate was 72.96%(143/196).The EBV-DNA level[median(P25,P75)]of peripheral blood mononuclear cells was 3.7×103 copies/L(1.6×103 copies/L,8.8×103 copies/L).The incidence of hepatosplenomegaly(subcostal≥5 cm)in EBV infection group was higher than that in non-EBV infected group[14.69%(21/143)vs.3.77%(2/53),χ^2=4.45,P=0.035].There was no significant difference in the number of white blood cells and the incidence of abnormal karyotype between EBV infection group and non-EBV infection group(both P>0.05).The secondary infection rate in EBV infection group was higher than that in the non-EBV infection group[41.96%(60/143)vs.24.53%(13/53),χ^2=5.03,P=0.025],and the remission rate of day 46 in EBV-infection group was lower than that in non-EBV infection group[80.42%(115/143)vs.98.11%(52/53),χ^2=9.60,P=0.020].The recurrence rate in EBV-infection group was higher than that in non-EBV infectious group[11.89%(17/143)vs.1.89%(1/53),χ^2=4.64,P=0.031],and there was a significant difference in the component ratio of immunophenotyping and clinical risk between the two groups(both P<0.05).Conclusions The hepatosplenomegaly in children with ALL complicated with EBV infection is obvious,the secondary infection rate is high,the remission rate is low,the recurrence rate is high,and the prognosis is poor.EBV infection may be related to immunophenotyping and clinical risk in children with ALL,and has nothing to do with the abnormal karyotypes.