人巨细胞病毒感染对儿童急性淋巴细胞白血病化疗的影响及危险因素分析  

Effect of Human Cytomegalovirus Infection on Chemotherapy of Children with Acute Lymphoblastic Leukemia and Analysis of Risk Factors

作　　者：李革 余怡如 陈放 LI Ge;YU Yiru;CHEN Fang(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院,湖北武汉430030

出　　处：《中国医学创新》2023年第10期23-27,共5页Medical Innovation of China

摘　　要：目的:分析儿童急性淋巴细胞白血病(ALL)化疗期间并发人巨细胞病毒(HCMV)感染的临床特点,探究诱发HCNV感染的危险因素,观察HCMV感染对ALL化疗效果的影响。方法:抽取144例华中科技大学同济医学院附属同济医院2015年3月-2017年2月收治的ALL患儿为研究对象,其中HCMV病原学检查呈阴性者作为对照组(n=91),HCMV病原学检查呈阳性者作为试验组(n=53)。观察两组患儿实验室检查情况,分析并发HCMV感染患儿临床特点,采用logistic回归分析诱发HCMV感染的危险因素,并比较HCMV感染对近远期治疗效果的影响。结果:ALL合并HCMV感染患儿多伴有不同程度呼吸道症状、胃肠道症状;单因素分析显示,试验组年龄、最低中性粒细胞计数、最低血小板值显著低于对照组,诱导缓解期感染率、免疫功能下降发生率均显著高于对照组(P<0.05);多因素分析显示,最低中性粒细胞计数下降、最低血小板值下降是诱发HCMV感染的独立危险因素(P<0.05);试验组化疗总有效率(88.68%)显著低于对照组(97.80%)(P<0.05);随访5年,试验组复发率(11.32%)显著高于对照组(2.20%)(P<0.05),试验组死亡率(1.89%)与对照组(1.10%)比较,差异无统计学意义(P>0.05)。结论:ALL患儿最低中性粒细胞计数降低、最低血小板值降低会增加HCMV感染风险,ALL化疗期间感染HCMV后会引起呼吸道症状、胃肠道症状,并发HCMV感染患儿的化疗效果较差、复发风险更高。Objective:To analyze the clinical characteristics of children with acute lymphoblastic leukemia(ALL)complicated with human cytomegalovirus(HCMV)infection during chemotherapy,explore the risk factors of HCNV infection,and observe the influence of HCMV infection on the chemotherapy effect of ALL.Method:A total of 144 children with ALL who were admitted to Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from March 2015 to February 2017 were selected as the research subjects,among which those who were negative for HCMV etiology examination were taken as the control group(n=91),and those who were positive for HCMV etiology examination were taken as the experimental group(n=53).The laboratory conditions of children in the two groups were observed,and the clinical characteristics of children complicated with HCMV infection were analyzed.The logistic regression analysis was used to analyze the risk factors of HCMV infection,and the influence of HCMV infection of short-term and long-term therapeutic effects were compared.Result:Children with ALL complicated with HCMV infection were mostly accompanied respiratory symptoms and gastrointestinal symptoms in different degrees.Univariate analysis showed that the age,the lowest neutrophil count and the lowest platelet value in the experimental group were significantly lower than those in the control group,and the incidence of infection rate in the induction remission period and immune function decline was significantly higher than those in the control group(P<0.05).Multivariate analysis showed that the decrease of the lowest neutrophil count and the lowest platelet value were independent risk factors for HCMV infection(P<0.05).The total effective rate of chemotherapy in the experimental group(88.68%)was significantly lower than that in the control group(97.80%)(P<0.05).After 5 years of follow-up,the recurrence rate(11.32%)of the experimental group was significantly higher than that of the control group(2.20%)(P<0.05).There was no significant

关 键 词：儿童 急性淋巴细胞白血病 人巨细胞病毒感染 化疗 危险因素 

分 类 号：R733.71[医药卫生—肿瘤]