儿童急性B淋巴细胞白血病ACTH异常临床特征与预后分析  

Abnormal Clinical Features and Prognosis of ACTH in Pediatric Acute B Lymphocytic Leukemia

作　　者：聂琪 刘莉 田玥[1,3] 毛晓燕 郭渠莲 田新 NIE Qi;LIU Li;TIAN Yue;MAO Xiaoyan;GUO Qulian;TIAN Xin(Dept.of Hematology and Oncology,Kunming Children’s Hospital/Affiliated Children’s Hospital of Kunming Medical University,Kunming Yunnan 650228;School of Clinical Medicine,Dali University,Dali Yunnan 671003;School of Clinical Medicine,Kunming Medical University,Kunming Yunnan 650500;Dept.of Pediatrics,Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000,China)

机构地区：[1]昆明市儿童医院/昆明医科大学附属儿童医院血液肿瘤科,云南昆明650228 [2]大理大学临床医学院,云南大理671003 [3]昆明医科大学临床医学院,云南昆明650500 [4]西南医科大学附属医院儿科,四川泸州646000

出　　处：《昆明医科大学学报》2024年第10期75-84,共10页Journal of Kunming Medical University

基　　金：四川省科技计划基金资助项目(2022YFS0622,2022YFS0622-B4)。

摘　　要：目的探讨促肾上腺皮质激素(ACTH)异常儿童急性B淋巴细胞白血病的临床特征及预后情况。方法收集2019年1月至2023年1月昆明市儿童医院血液科收治的54例B-ALL患儿为研究对象,根据是否存在ACTH降低分为降低组75例,正常组79例,收集患者临床资料进行比较,分析影响预后的危险因素。结果2组基线资料(性别,民族,年龄)、化疗次数、病情严重程度、血红蛋白、血小板计数、原始细胞百分比、复发率、死亡率、无事件生存率、总生存率、单因素、多因素COX回归分析临床因素对OS率的影响差异均无统计学意义(P>0.05),外周血白细胞计数及分组、糖皮质激素(GC)抵抗率、MRD阳性率以及单因素Cox回归分析中年龄≥10岁、伴有中枢神经系统白血病、白细胞计数、白细胞分组(<50×10^(9)/L vs≥50×10^(9)/L)对初诊B-ALL患儿EFS率的影响差异有统计学意义(P<0.05),睾丸浸润、血小板计数、血红蛋白水平、骨髓原始细胞计数、皮质醇水平、ACTH水平、性别、MRD、民族、分组(ACTH正常组VS ACTH降低组)、病情严重程度对初诊B-ALL患儿EFS率的影响差异无统计学意义(P>0.05)。进一步行多因素Cox逐步回归分析(方法:向前,有条件)发现白细胞计数≥50×10^(9)/L、年龄≥10岁是患儿EFS率的独立不良预后因素(P<0.05)。结论ACTH降低的B-ALL患儿GC抵抗率、MRD阳性率、白细胞计数更高,白细胞计数≥50×10^(9)/L、年龄≥10岁是患儿EFS率的独立不良预后因素。Objective To explore the clinical characteristics and prognosis of acute B lymphocytic leukemia in children with abnormal adrenal corticotropic hormone(ACTH).Methods A total of 154 children with B-ALL admitted to the hematology Department of Kunming Children’s Hospital from January 2019 to January 2023 were collected as the study objects.According to whether ACTH decreased,they were divided into the reduced group(75 cases)and the normal group(79 cases).Clinical data of the patients were collected for comparison,and the risk factors affecting the prognosis were analyzed.Results The baseline data from two groups(gender,ethnicity,age),number of chemotherapy sessions,severity of illness,hemoglobin levels,platelet counts,percentage of blast cells,relapse rates,mortality rates,event-free survival rates,overall survival rates,and both univariate and multivariate COX regression analyses of clinical factors affecting OS rates showed no statistical significance(P>0.05).However,peripheral blood leukocyte counts and groupings,glucocorticoid(GC)resistance rates,MRD positivity rates,and in the univariate Cox regression analysis,age≥10 years,presence of central nervous system leukemia,leukocyte counts,and leukocyte groupings(50×10^(9)/L vs≥50×10^(9)/L)had a statistically significant impact on the EFS rates of newly diagnosed B-ALL patients(P<0.05).Testicular infiltration,platelet counts,hemoglobin levels,bone marrow blast cell counts,cortisol levels,ACTH levels,gender,MRD,ethnicity,groupings(normal ACTH group vs reduced ACTH group),and severity of illness on the EFS rates of newly diagnosed B-ALL patients was not statistically significant(P>0.05).Further multivariate Cox stepwise regression analysis(method:forward,conditional)revealed that leukocyte counts≥50×10^(9)/L and age≥10 years are independent adverse prognostic factors for the EFS rates in these patients(P<0.05).Conclusion Children with BALL with reduced ACTH had higher rates of GC resistance,MRD positivity,and white blood cell count,≥50×10^(9)/L and age

关 键 词：白血病 肾上腺功能 GC抵抗 预后 

分 类 号：R725.5[医药卫生—儿科]