某医院810例儿童白血病流行病学特征分析

Epidemiological characteristics of 810 children with leukemia

摘要:

目的：探讨儿童白血病发病趋势、危险因素及预后，为白血病的预防和诊治提供科学依据。方法：回顾性分析重庆医科大学附属儿童医院2014年1月至 2018 年12月收治的810例川渝地区儿童白血病病例年龄、性别、发病季节、首诊症状、形态学分类、免疫学分型、细胞遗传学分型及分子生物学分型等流行病学资料，并通过二元logistic回归分析儿童白血病转归的影响因素。结果：810例白血病患儿中男孩发病人数多于女孩，其中急性淋巴细胞白血病（acute lymphoblastic leukemia，ALL）的各年龄阶段男孩发病人数均较女孩多。ALL在1~4岁年龄段人数最多（50.93%），急性髓细胞白血病（acute myeloid leukemia，AML）患儿的发病年龄分布差异不明显。10%的患儿有家族肿瘤史，34.44%的患儿存在有毒化学物质暴露史。MICM分析显示，形态学分类以ALL为主（79.26%）；免疫学分型以急性B淋巴细胞白血病（acute B-lymphocytic leukemia，B-ALL）为主；染色体核型异常检出率为41.56%；ALL患儿ETV6/RUNX1检出率最高（14.86%），急性T淋巴细胞白血病（acute T-lymphocytic leukemia，T-ALL）患儿的阳性融合基因均为SIL/TAL1，AML患儿中PML/PARα检出率最高（35.25%）。二元logistic回归分析结果显示，家族肿瘤史、细胞遗传学分型、ETV6/RUNX1融合基因为白血病转归的影响因素，OR值分别为5.234（1.166~23.485）、3.442（1.666~7.115）、0.131（0.031~0.556）。结论：家族肿瘤史、细胞遗传学分型、ETV6/RUNX1融合基因可能是白血病转归的预测因素，存在家族肿瘤史和非低危型细胞遗传学可能为白血病预后的危险因素，ETV6/RUNX1融合基因阳性可能为保护因素。

Abstract:

Objective：To analyze the new 810 cases of childhood leukemia in the past five years，and to explore its incidence trend，risk factor and prognosis，laying a foundation for the prevention and treatment of leukemia. Methods：The epidemiological data of 810 cases of childhood leukemia in our hospital from January 2014 to December 2018 were retrospectively analyzed，including age，gen－der，onset season，initial symptoms，morphology classification，immunology typing，cytogenetics typing and molecular biology typing. And the influencing factor of children’s leukemia outcome were obtained through binary logistic regression. Results：Among the 810 children with leukemia，the number of boys was more than that of girls，and the number of boys with acute lymphoblastic leukemia（ALL） at all ages was higher than that of girls. ALL was most common in 1-4 years age group，but there was no significant difference in the age distribution of acute myeloid leukemia. Patients of 10% had a family history of cancer and 34.44% had been exposed to toxic chemicals. According to results of MICM，ALL took dominant position in morphology classification（79.26%）；acute B-lymphocytic leukemia（B-ALL） took dominant position in immunology typing；patients had clonal abnormalities had a detection rate of 41.56%；the highest positive rate of ETV6/RUNX1（TEL/AML1） in children with ALL was 14.86%；the positive fusion gene in children with acute T-ALL was SIL/TAL1；the detection rate of PML/PARα in children with acute myeloid leukemia（AML） was the highest（35.25%）. Results of binary logistic regression analysis showed that family tumor history，cytogenetic typing and ETV6/RUNX1 fusion gene were influencing factors of leukemia outcome，and OR values were 5.234（1.166-23.485），3.442（1.666-7.115） and 0.131（0.031-0.556），respectively. Conclusion：Family tumor history，cytogenetic typing and ETV6/Runx1 fusion gene may be the pre－dictive factors of leukemia prognosis. The family tumor history and non-low-risk cytogenetics may be the risk factors of leukemia prognosis，and the positivity of ETV6 / Runx1 fusion gene may be the protective factor.