肿瘤患儿化学治疗后血清麻疹抗体水平的调查

Seroprevalence of serum measles antibody in children with tumor after chemotherapy

目的调查肿瘤患儿的血清麻疹抗体水平,为该类患儿麻疹疫苗免疫策略提供支持。方法收集2016年1月至2018年12月复旦大学附属儿科医院血液科、肿瘤外科确诊为血液肿瘤或实体瘤且接受过化学治疗患儿的血标本,应用酶联免疫吸附测定法定量检测麻疹抗体IgG水平,动态监测化学治疗过程中麻疹抗体水平的变化。统计学分析采用Kruskal-Wallis检验和χ^(2)检验。结果共纳入441例肿瘤患儿,麻疹抗体阳性率为79.1%(349/441),43.3%(191/441)的患儿具有保护性抗体。年龄<8月龄、8月龄至<2岁、2岁至<6岁、≥6岁患儿的抗体保护率差异有统计学意义(χ^(2)=15.647,P<0.01);2岁至<6岁和≥6岁患儿血清麻疹抗体保护率差异无统计学意义[43.8%(95/217)比41.1%(58/141),P>0.05]。血液系统肿瘤患儿与实体瘤患儿的麻疹抗体保护率分别为45.6%(78/171)和41.9%(113/270),差异无统计学意义(P>0.05)。16.3%(16/98)的患儿在化学治疗过程中抗体效价下降至保护性抗体效价水平以下。患儿结束化学治疗后6个月内、6个月至<1年、1年至<2年、≥2年时检测的血清抗体保护率差异无统计学意义(P>0.05)。结论50%以上的肿瘤患儿在化学治疗后血清麻疹抗体低于保护水平,化学治疗降低麻疹保护性抗体水平,应推荐此类特殊人群在评估后进行麻疹成分疫苗的再接种,从而获得麻疹的免疫保护力。

Objective To investigate the serum measles antibody in children with tumor and to provide the clinical evidence for measles vaccination strategy for this special population.Methods From January 2016 to December 2018,the blood samples of children who were diagnosed with hematological malignancy or solid tumors and received chemotherapy in the Department of Hematology or Oncology Surgery of Children′s Hospital of Fudan University were collected.Enzyme-linked immunosorbent assay was used to quantitatively detect the level of measles IgG antibody,and dynamically monitor the changes of measles antibody level during chemotherapy.Kruskal-Wallis test and chi-square test were used for statistical analysis.Results A total of 441 children with tumors were enrolled,with the positive rate of measles antibody of 79.1%(349/441),and only 43.3%(191/441)of children had the protective level of IgG antibody.There was a statistically significant difference of the antibody protection rate in children aged<eight months old,eight months old to<two years old,two years old to<six years old,and≥six years old(χ^(2)=15.647,P<0.01).There was no statistically significant difference of the protection rate of serum measles antibody between children aged two to<six years and≥six years(43.8%(95/217)vs 41.1%(58/141),P>0.05).The protection rate of serum measles antibody in children with hematological malignancy and solid tumor were 45.6%(78/171)and 41.9%(113/270),respectively,and there was no statistically significant(P>0.05).There were 16.3%(16/98)of children who were observed to lose the pre-existing protective antibody during chemotherapy.There was no statistically significant difference of the protection rate of serum among children who had finished chemotherapy<six months,six months to<one year,one year to<two years,and≥two years(P>0.05).Conclusions Serum measles antibody is below the protective level in more than 50%of children with malignancy after chemotherapy.Chemotherapy can compromise the protective antibody against measles.It is recommended for this special population to re-schedule measles vaccine after individualized evaluation to acquire the immuneprotection against measles.