Childhood leukemia genetic bottleneck phenomenon related to TEL-AMLI： the postulation by a mathematical model

Childhood leukemia bottleneck phenomenon is the most mysterious corollary of the prenatal origin discovery of leukemogenic chromosome translocations. The bottleneck is evidence that leukemia initiation, by in utero acquired chromosome translocations that generate functional fusion genes, is far more common than the incidence rate of corresponding leukemia. For childhood TEL-AML1 ^＋ acute lymphoblastic leukemia （ALL） this equates to approximately 100 times. Practically this means that among a hundred children born with TEL-AML1 fusion gene, only one child will later in its life develop ALL. The key data necessary for unraveling of this mystery were discovered in 2002. It was the level of TEL-AML1^＋cells＇ frequency. The bottleneck is caused by the very low body TEL-AML1^＋cell count. Only one out of a thousand B cells carries TEL-AML1 fusion gene. TEL-AML1^＋body cell count is low because TEL-AML1 fusion is generated at cell level of 103 to 104 just during the late fetal lymphopoiesis i.e. after the 36th gestational week.

DNA repair gene XRCC1 polymorphisms and susceptibility to childhood acute lymphoblastic leukemia: a meta-analysis

Objective： To estimate the relationship between genetic polymorphisms of X-ray repair cross- complementing group 1 （XRCC1） and the susceptibility to childhood acute lymphoblastic leukemia （ALL）. Methods： Relevant case-control studies were enrolled in the meta-analysis. We applied Rev Man 4.2 software to pool raw data and test studies＇ heterogeneity and to calculate the incorporated odds ratio （OR） and 95% confidence interval （95% CI）. Results： Our data showed that the OR for the Gln allele of the Arg399Gln polymorphism, compared with the Arg allele, was 1.35 （95% CI, 1.16-1.57; P〈0.0001） for childhood ALL patients. Similarly, the homozygous genotype Gln/Gln and heterozygous genotype Arg/Gln both significantly increased the risk of childhood ALL compared with the wild genotype Arg/Arg （OR =1.58; 95% CI, 1.13-2.21; P=0.008; OR =1.51; 95% CI, 1.21-1.87; P=0.0002）. The dominant model of Arg399Gln was associated with childhood ALL risk （OR =1.54; 95% CI, 1.25-1.89; P〈0.0001）. The ethnic subgroup analysis demonstrated that the Gln allele in all five ethnic groups was prone to be a risk factor for childhood ALL just with different degrees of correlation while Arg194Trp SNP showed a protective or risk factor or irrelevant thing in different races. Conclusions： XRCC1 399 polymorphism may increase the risk of childhood ALL. Different ethnic groups with some gene polymorphism have different disease risks.

Acute Lymphoblastic Leukemia in Childhood Following Pyoderma Gangrenosum

Pyoderma gangrenosum (PG) is a rare but serious ulcerating skin disease that occurs either idiopathically or associated with various systemic diseases and malignant tumors. Although the association of PG with myeloid malignant tumors is well known, their association with lymphoid malignant tumors, especially in children is extremely rare. We present here a case of PG in a 4-year and 4 months female child, diagnosed in the Pediatrics department, which had initially evolved well with oral corticosteroid therapy and a local dermocorticoid. The development was marked 7 months after stopping corticosteroid treatment by the occurrence of acute lymphoblastic leukemia. This case of PG is presented in the intention of increasing awareness of this uncommon condition with may occurring in association with haematological malignancy. PG may precede, develop concurrently with, or follow various conditions.

1例口服雄黄制剂致白血病患儿急性砷中毒死亡原因分析

目的 探讨雄黄制剂致急性砷中毒的原因。方法 回顾性分析1例口服雄黄制剂致白血病患儿急性砷中毒的诊治过程,总结雄黄制剂治疗儿童白血病的砷中毒特点及治疗注意事项。结果 患儿雄黄日用量为1 g,远高于单味日用量50~100 mg;临床症状为多器官功能衰竭,尿砷含量为33.56μmol/L,远超过人体尿砷正常值1.8μmol/L,诊断为急性砷中毒。结论 该患儿雄黄日用量属超剂量用药。雄黄制剂的剂量和疗程应符合药品说明书要求,不可长期和超量服用,一旦出现心律失常和心电图QT间期延长等砷中毒症状时应立即停药,保证用药安全。

TEL/AML1融合基因儿童急性白血病的临床特点与预后

目的通过对71例TEL/AML1阳性的儿童急性白血病患儿行回顾性分析,明确该融合基因阳性白血病的临床特点,并评估其预后关系。方法2015年11月至2023年7月上海市儿童医院单中心71例TEL/AML1融合基因阳性的急性白血病患儿,男36例,女35例,年龄2~15岁,所有患儿均进行MICM的诊断,除形态、免疫分型和细胞遗传学外,均应用实时荧光探针PCR法进行56种融合基因筛选,并同步予FISH的方法行TEL/AML1探针检测。结果71例患儿PCR法和FISH结果均显示TEL/AML1融合基因阳性,符合率100%。71例患儿中位生存时间为54个月,其中持续缓解59例,放弃6例,死亡2例,复发4例,5年无事件生存率(EFS)是83.2%,5年累积复发率为5.6%。其中2例复发后放弃,另外2例复发患儿经过Car-T和造血干细胞移植后持续缓解至今。有1例患儿停药5年后复发,尽管加强化疗和移植,仍未改善预后,最后死亡;另外1例因高白细胞血症,在诱导缓解期间因感染而死亡。除放弃的6例外,将其他65例分为缓解组(59/65)和非缓解组(6/65),通过对两组多因素分析发现年龄≥6岁,危险分层以及D19d MRD≥0.1%是影响预后的危险因素。结论TEL/AML1融合基因阳性的急性白血病患儿可以获得较高的缓解率,常规化疗就可让其预后较好,诱导缓解后的MRD水平等可为后续治疗方案调整提供依据,复发后应用Car-T联合造血干细胞移植有望进一步改善其预后。

内服外用联合防治儿童白血病化疗性口腔溃疡的临床研究

目的:观察内服外用联合应用防治儿童白血病化疗性口腔溃疡的临床疗效。方法:选取2020年9月—2022年12月收治的白血病患儿80例,随机分为观察组和对照组,每组40例。两组均采用标准化疗方案化疗(方案参照王卫平主编《儿科学》第九版、儿童急性髓细胞白血病诊疗建议、CCCG-ALL2015方案)。对照组患儿出现口腔溃疡后用康复新液或亚叶酸钙稀释液漱口,观察组每疗程化疗期间均口服叶酸片,出现口腔溃疡后给予制霉菌素片磨粉加生理盐水稀释后漱口+巨和粒加生理盐水稀释后漱口。两组均连续治疗5 d。观察两组患儿化疗性口腔溃疡发生率、严重程度、疼痛程度、临床疗效、患儿依从性及不良反应情况。结果:观察组化疗性口腔溃疡发生率低于对照组,严重程度轻于对照组,差异有统计学意义(P<0.05);观察组患儿依从性高于对照组,差异有统计学意义(P<0.05);两组患儿疼痛程度、临床治疗总有效率比较,差异无统计学意义(P>0.05);两组患儿治疗期间均未发生与化疗性口腔溃疡药物治疗相关的不良反应。结论:内服外用联合应用可预防儿童白血病化疗性口腔溃疡的发生,降低严重程度,且对化疗性口腔溃疡具有良好效果,利于缓解患儿疼痛感及溃疡面愈合,提高患儿化疗依从性,且安全性较高。

急性早幼粒细胞白血病患儿组织砷残留和生活质量的横断面研究

目的调查接受砷剂(ATO和RIF)治疗的急性早幼粒细胞白血病(APL)患儿组织中砷浓度和健康相关生活质量。方法于2022年7月11日—2022年9月7日开展一项横断面研究,期间36名APL患儿和17名健康儿童(对照组)纳入该研究。收集研究对象血浆、尿液、头发和指甲样本,测定各组织砷浓度。采用中文版PedsQL4.0普适性核心量表测定APL患儿健康相关生活质量。结果仅在停用砷剂(ATO和RIF)治疗不足3个月时,APL患儿各组织砷浓度高于健康儿童,有统计学差异。26例APL患儿完成了中文版PedsQL4.0普适性核心量表,在生理功能、情感功能、社会功能、学校表现四个类目及总分维度,不同砷浓度组别间无统计学差异,各类目总体得分基本接近正常人群。结论在使用砷剂(ATO和RIF)后,3个月内APL患者组织中的砷浓度会高于正常水平,之后会恢复正常。在不同砷残留水平的APL患儿之间未观察到健康相关生活质量的差异,提示APL患儿组织中的砷残留不是健康相关生活质量的直接影响因素。

Coping Strategies among Parents of Children with Acute Lymphoblastic Leukemia

Background: Having a child with acute lymphoblastic leukemia represents challenges to the family which may impact their quality of life. In such circumstances, parents use various coping strategies to face this stressful situation, and understanding the relation of coping strategies on quality of life among parents of children with acute lymphoblastic leukemia may provide professionals with ideas about how to support them which in turn may improve their quality of life. Aim: The aim of the present study was to assess the correlation between coping strategies and the health related quality of life of parents whose children are suffering from acute lymphoblastic leukemia. Study design: A cross-sectional design using guided self-administered questionnaire by a single researcher was used. Methods: A universal sample consisted of 299 parents of children with acute lymphoblastic leukemia (ALL) was recruited from Hospital Universiti Kebangsaan Malaysia and Kuala Lumpur Institute Pediatrics. The response rate was 98%. The data collection tools were WHOQOL BREF which is the World Health Organization Quality of Life shorter version and Brief COPE questionnaires. Results: The results revealed that half of the parents perceived their health related quality of life as good. The highest scores for parents were reported on the social relationship domain meanwhile the lowest were reported on the environmental health domain. In regard to the coping strategies, it was found that religion was most frequently used while humor was the least to be used. Moreover, there was a significant positive relationship between quality of life of the parents and problem-focused coping style and a significant negative relationship with emotion-focused coping style. Conclusion: On the basis of the finding of present study, an appropriate intervention could be design to include program that promote the use of problem-focused copings such as active coping and planning and discourage the use of emotion-focused copings such as self-blaming to enhance parents’ health related quality of life.

Angiogenic and FLT3 Receptors Expression in Acute Lymphoblastic Leukemia in Pediatric Age Group

Angiogenesis has an important role in pathophysiology of cancer. FMS-like tyrosine kinase 3 (FLT3) is implicated in hematopoietic malignancies. Their role in childhood acute lymphoblastic leukemia (ALL) pathogenesis needs more enlightenment. Expression of vascular endothelial growth factor receptor-1 and -2 (VEGFR-1 and -2), as well as FLT3 were assessed by flow cytometry in bone marrow (BM) blasts of 55 newly diagnosed children with ALL. Patients included B cell ALL (B-ALL) group (n = 41) and T cell ALL (T-ALL) group (n = 14). Comparison between groups revealed a significant increase in blasts percent (%) expressing FLT3 and FLT3 intensity detected in B-ALL group (p = 0.004 and p = 0.02, respectively). In B-ALL patients, a significant positive correlation was seen between blasts % expressing FLT3 and blasts percentage infiltrating BM (r = 0.405;p = 0.009), also positive correlation was seen between % of blasts expressing VEGFR-1 and VEGFR-2 (r = 0.704;p 0.001). In T-ALL group, blast % expressing FLT3 revealed significant positive correlations with blast % expressing VEGFR-1, and those expressing VEGFR-2 (r = 0.627;p = 0.016, and r = 0.654;p = 0.011, respectively). In addition, significant correlation was seen in blasts % expressing all;FLT3, VEGFR-1 and -2, with blasts % expressing stem cell marker CD34 (r = 0.826;p = 0.001, r = 0.596;p = 0.041, and r = 0.798;p = 0.002, respectively). Conclusion: Expression of VEGFR-1, VEGFR-2 and FLT3 were demonstrated and linked on leukemic blasts of ALL which highlights their role in pathogenesis. FLT3 expression plays a role in facilitating blasts proliferation in BM in B-ALL. FLT3, VEGFR-1 and -2 could be used in future profiling of CD34+ leukemic stem cell pool in T-ALL.

异基因造血干细胞移植术治疗儿童白血病的效果观察及复发影响因素分析

目的 分析异基因造血干细胞移植术(allo-HSCT)治疗儿童白血病的效果,并探讨其复发影响因素。方法回顾性选取82例白血病患儿,均行allo-HSCT治疗,并观察allo-HSCT治疗效果。于移植后随访2年,统计复发情况,同时收集患儿一般资料,采用单因素和多因素Logistic回归分析allo-HSCT后复发的相关影响因素。结果 82例经allo-HSCT治疗白血病患儿均全部植入成功,完全缓解(CR)、部分缓解(PR)分别为80例、2例;移植后随访2年,有16例复发,占比19.51%。复发组与未复发组患者年龄、性别、供者来源、移植物来源、疾病类型、供者人类白细胞抗原(HLA)相合程度、巨细胞病毒感染、急性移植物抗宿主病(GVHD)比较,差异无统计学意义(P>0.05);复发组诱导疗程数多、无慢性GVHD、移植前伴髓外病变占比高于未复发组,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,诱导疗程数多、无慢性GVHD、移植前伴髓外病变均是allo-HSCT后复发的独立危险因素。结论 诱导疗程数多、无慢性GVHD、移植前伴髓外病变均是allo-HSCT后复发的独立危险因素,临床应给予高度重视。

Evolution of the Outcomes of Children with Acute Leukemia in Congo

Background: To lower the mori-mortality related to the aggressiveness of acute leukemia’s chemotherapy regimens, we have implemented in 2017 two low toxicity chemotherapy regimens and new supportive care strategies. The aim of the study is to evaluate our new treatments. Materials and Method: A retrospective study was carried out from January 2014 to May 2021 in the hematology department of the teaching hospital in Brazzaville. The study concerned 47 children diagnosed with acute leukemia. Participants were divided into two groups: acute leukemia diagnosed before 2017 (group 1: 23 children) and after 2017 (group 2: 14 children). They were compared using the chi-square. Results: The median age was 10.0 ± 5.01 years. Features and outcomes of group 2 were better. The median duration of symptoms was shorter: 2.45 ± 2.87 months (p = 0.036). The Karnosky score was higher (p = 0.002) and white blood cell count lower (p = 0.331). Both groups started the treatment with a delay of 6 days. The induction treatment was completed in 69.6% before 2017 versus 93.3% after. The rate of relapse was more important for group 1: 85.7% versus 14.3% (p = 0.01). Conclusion: Trainings of professionals have improved the characteristics outcomes of our patients and should be pursued. Considering the high relapse rate, our protocol will need to be intensified.

儿童急性T淋巴细胞白血病的临床特征及预后分析

目的分析儿童急性T淋巴细胞白血病(T-ALL)的临床特征、预后因素及生存情况。方法回顾性分析2008年4月—2020年8月于首都儿科研究所附属儿童医院血液内科确诊的84例T-ALL临床和实验室资料。并将非早前T淋巴细胞(non-ETP)-ALL组与早前T淋巴细胞(ETP)-ALL组进行比较。结果non-ETP组共70例(83.3%),ETP组共14例(16.7%)。与non-ETP组相比,ETP组女性比例高、LDH明显增高者比例低、高危者比例高、诱导失败者比例高(P<0.05)。non-ETP组完全缓解(CR)率为87.1%,ETP-ALL组CR率为57.1%。non-ETP组复发19例,死亡15例;ETP组复发3例,死亡3例。non-ETP-ALL及ETP-ALL组的5年的总生存率(OS)分别为:(77.1±5.3)%vs.(74.5±13.1)%(P=0.979)。两组患儿5年的无事件生存率(EFS)分别为:(64.2±6.0)%vs.(50±13.4)%(P=0.098)。通过Kaplan-Meier分析进行单因素分析显示,诱导失败及复发为影响OS的因素(P<0.05)。采用Cox多因素分析显示,复发为影响预后的独立因素(P<0.001)。纳入所有因素进行logistic回归分析显示,高危险度将直接增加复发风险,具有统计学意义(P=0.047)。结论儿童T-ALL诱导失败及复发为预后影响因素,复发为预后的独立危险因素。non-ETP-ALL组与ETP-ALL组的5年OS及EFS均无明显统计学差异。

lncRNA GATA3-AS1靶向miR-515-5p对儿童急性淋巴细胞白血病细胞增殖和凋亡的影响

目的:探讨长链非编码RNA(lnc RNA)GATA3反义RNA1(GATA3-AS1)靶向mi R-515-5p对儿童急性淋巴细胞白血病(ALL)细胞增殖和凋亡的影响。方法:RT-q PCR检测对照者和ALL患儿血浆中GATA3-AS1和mi R-515-5p的表达水平。将人ALL细胞Jurkat分为si-GATA3-AS1、si-NC、mi R-NC、mi R-515-5p、si-GATA3-AS1+anti-mi R-NC和si-GATA3-AS1+anti-mi R-515-5p共6组。CCK-8法检测细胞增殖,流式细胞术分析细胞凋亡,双荧光素酶报告实验用于确定GATA3-AS1和mi R-515-5p的靶向关系。结果:ALL患儿血浆中GATA3-AS1表达水平显著高于对照者(P<0.001),mi R-515-5p表达水平显著低于对照者(P<0.001)。与si-NC组比较,si-GATA3-AS1组细胞抑制率、凋亡率、mi R-515-5p表达水平显著升高(P<0.001)。与mi R-NC组比较,mi R-515-5p组细胞抑制率、凋亡率显著升高(P<0.001)。GATA3-AS1与mi R-515-5p直接特异性结合。与si-GATA3-AS1+anti-mi R-NC组比较,si-GATA3-AS1+anti-mi R-515-5p组细胞抑制率、凋亡率显著降低(P<0.001)。结论:下调GATA3-AS1可通过靶向上调mi R-515-5p的表达抑制儿童ALL细胞增殖,并诱导细胞凋亡。

Snail基因在小儿急性淋巴细胞性白血病中的表达及预后价值

目的 观察Snail基因在小儿急性淋巴细胞性白血病(ALL)中的表达水平,探讨其在ALL中的预后价值。方法 应用实时定量荧光定量聚合酶反应(RT-PCR)检测42例小儿ALL患者骨髓中的Snail mRNA表达,并结合初诊时临床特征进行分析。结果 (1)初诊时高白细胞组的Snail mRNA表达显著高于非高白细胞组[(32.38±2.34)vs(25.06±1.94),P<0.001];(2)治疗后达完全缓解/部分缓解组的Snail mRNA表达明显低于未缓解组[(13.89±3.54)vs(25.98±4.21),P<0.001];(3)有中枢神经系统白血病(CNS-L)组的Snail mRNA明显高于无CNS-L组[(26.47±5.59)vs(19.62±3.28),P<0.001];(4)Snail基因表达与危险分层具有明显相关性(P=0.0001),低危组Snail基因表达显著低于中危组(P=0.001)与高危组(P=0.0001),但中危与高危组间比较差异无统计学意义(t=1.37,P=0.18)。结论 Snail基因表达与初诊时白细胞数、危险分层及疗效密切相关,且与小儿ALL的CNS浸润呈正相关,可作为疗效判断与预测继发CNS-L发生的潜在观察指标。

儿童急性淋巴细胞白血病粒缺期并发急性阑尾炎8例诊治体会

目的探讨儿童急性淋巴细胞白血病中性粒细胞减少期合并急性阑尾炎的诊断、治疗方法、手术时机及预后。方法回顾性分析2018年—2021年8例在我院儿童血液肿瘤科确诊急性淋巴细胞白血病、粒缺期合并急性阑尾炎的病例。结果8例中内科保守治疗成功1例(1/2),保守治疗后阑尾复发1例(1/2);急诊手术3例(3/6),延迟手术3例(3/6),8例总治疗时间12-29d(15.5±5.463d),7例手术病人外科住院时间3-10d(4±2.43d)。术后病理活检提示肿瘤浸润0例、急性坏疽性阑尾炎伴穿孔1例、急性化脓性阑尾炎伴粪石嵌顿1例、急性化脓性阑尾1例、急性化脓性阑尾炎伴阑尾周围脓肿1例、急性单纯性阑尾炎3例。并发腹腔积液2例、局限性腹膜炎2例、阑尾周围脓肿2例、麻痹性肠梗阻1例、肠粘连1例。结论对于儿童急性淋巴细胞白血病粒缺期合并急性阑尾炎者,内科保守治疗可能导致阑尾炎复发,急诊手术治疗术后并发症多,感染风险大。目前,可采用内科保守治疗,待中性粒细胞回升后行腹腔镜阑尾切除术,以减少并发症、缩短住院时间,并可避免化疗方案长时间中断所致原发病复发。

血常规指标在儿童急性白血病诊断中的临床应用

目的 评价儿童急性白血病诊断中应用血常规指标检验的辅助价值,以提高儿童急性白血病诊断、治疗预后效果。方法 选择我院2018年12月至2019年12月血液科收治且检查确诊的急性白血病儿童以及体检健康儿童,各选择80例,分别作为观察组、对照组,两组儿童均进行血常规检测。结果 与对照组受试儿童的血常规指标检验结果相比,观察组白细胞、淋巴细胞比率、单核细胞比率均更高,红细胞、血小板、中性细胞比率均更低,差异显著,P均<0.05,具有统计学意义。观察组血常规指标白细胞计数> 10×10^(9)/L(50.00%)、血红蛋白浓度60~110 g/L(75.00%)、血小板计数<100×10^(9)/L(80.00%)、白细胞计数水平>10×10^(9)/L幼稚细胞检出率(96.00%)更高,差异显著,P<0.05。结论 急性白血病患儿多数病例可以检出幼稚细胞,为初诊提供可靠依据。

儿童白血病对口腔微生物影响的初步研究

目的研究白血病患儿口腔微生物分布情况,从病原学角度了解口腔感染的发生发展,探究口腔微生物与疾病之间的相关性。方法选取2021年10月至2022年10月在内蒙古自治区人民医院小儿血液科住院治疗的白血病患儿40例为观察组,选取同期健康儿童20例作为对照组,收集两组研究对象的唾液标本。对唾液进行微生物总DNA提取;采用16S rRNA基因带有barcode的特异引物对V4、V5区域进行扩增;利用Illumina PE250平台进行建库及测序,分析比较观察组同健康儿童口腔微生物的差异性以及白血病与口腔菌群的相关性。结果观察组菌群丰富度和均匀度均明显高于对照组,其口腔微生物多样性明显大于对照组;两组间优势菌群存在差异,采用Wilcoxon秩和检验分析,差异具有统计学意义(P<0.05)。结论白血病对儿童口腔微生物有影响,口腔微生物有望成为白血病早期诊断的检测指标,但目前暂无化疗、免疫抑制、抗生素暴露对白血病儿童口腔菌群影响的相关研究,除外其他因素影响可能,故还需要进一步深入研究。

GST基因多态性与儿童白血病易感性的关系

[目的 ]探讨谷胱甘肽S 转移酶M1(GSTM1)和T1(GSTT1)基因多态性与儿童白血病遗传易感性的关系。 [方法 ]采用病例 对照研究方法和多重PCR技术检测病例组和对照组的GSTM1和GSTT1缺失基因型的分布频率。 [结果 ]病例组中GSTM1缺失基因型的分布频率明显高于对照组 (OR =2 .18,95 %CI :1.0 2～ 4.67)。在男性病例中GSTM1缺失基因型的比例高于对照组 (P <0 .0 5 )。GSTM1与GSTT1在儿童白血病的发病中无交互作用。 [结论 ]GSTM1缺失基因型可能是儿童白血病的重要危险因素 ,男性患儿尤为明显 ;GSTT1基因多态性可能与儿童白血病无关 ;

儿童急性白血病的环境危险因素

目的 探讨环境因素对儿童白血病的影响 ,了解儿童白血病的可能危险因素。方法 采用病例-对照研究的方法 ,在FoxPro 6 0中建立数据库 ,运用SPSS 10 0进行统计分析处理。结果 单因素分析结果显示 ,家族遗传病史、X射线照射史、近 1年内感冒史、出生时的胎次 (第 1胎与第 2胎及以上 )、鱼肝油服用史、居室装修史、居室与高压电线的距离均与儿童白血病有关。多元非条件Logistic回归分析表明 ,除鱼肝油服用史 (比值比OR =0 3,95 %的可信区间CI =0 2～ 0 7)外 ,家族遗传病史 (OR =4 4 ,95 %CI =1 2～ 16 5 )、X线照射史 (OR =3 2 ,95 %CI =1 6～ 6 1)、近 1年内感冒史 (OR =2 6 ,95 %CI =1 2～ 5 5 )和居室装修史 (OR =2 0 ,95 %CI=1 0～ 3 9)是儿童白血病的重要危险因素。其中 ,居室装修史与儿童白血病之间的关系是首次报道 ,而服用鱼肝油具有保护作用。结论 家族遗传病史、X射线照射史、近 1年内感冒史和居室装修史是儿童白血病的重要危险因素。

重庆地区2000～2009年儿童白血病流行病学回顾性分析

目的:分析10年间重庆医科大学附属儿童医院收治的915例白血病患儿的流行病学资料,探讨重庆地区儿童白血病分布特征及规律。方法:对2000年1月至2009年12月我院收治的915例儿童白血病病例的流行病学资料进行回顾性分析。结果:10年间儿童白血病初发病例共915例,平均年增长速度19.6%。型别最多为急性淋巴细胞白血病(Acute lymphoblastic leukemia,ALL),ALL免疫表型中B系表达为主,初诊白血病核型异常率为47.59%。男性发病率高于女性。10岁以下白血病患儿737例占80.55%,ALL患儿以1～4岁组最多。结论:我院儿童白血病初发病例数呈逐年上升趋势,可能与环境污染加重及就诊病例数增加有关。重庆地区特有的儿童白血病流行病学特征,提示遗传及环境因素在白血病起源中作用,从而导致预后的差别。