摘要
目的探讨儿童急性淋巴细胞白血病(ALL)的临床特征及预后影响因素。方法回顾性分析近10年新乡医学院第一附属医院收治的132例ALL儿童的临床特征及预后因素,采用Kaplan-Meier法评估生存率,影响预后的单因素用log-rank检验,多因素COX回归模型分析出独立预后因素。结果本组ALL患儿中男女比例为1.28∶1,诊断时中位年龄5.45岁,发病年龄以1~10岁多见,主要初诊表现是发热、面色苍黄及肝、脾、淋巴结肿大。外周血象以白细胞升高、血红蛋白及血小板减低为主要表现。B-ALL占88.64%,T-ALL占11.36%,检测的融合基因中TEL/AML1阳性最常见占10.11%,异常核型中超二倍体最常见占5.38%。ALL患儿5年总生存率(OS)为(85.82±3.39)%,5年无事件生存率(EFS)为(70.80±4.17)%。单因素预后分析显示,初诊年龄(χ^2=15.65,P=0.00)、白细胞计数(χ^2=10.22,P=0.01)、染色体核型(χ^2=6.48,P=0.04)、危险度分组(χ^2=27.83,P=0.00)对预后的影响均有统计学意义。多因素COX回归分析显示,危险度分组是影响预后的独立危险因素(HR:1.76,95%CI:1.02~3.02,P=0.03)。结论儿童ALL发病年龄多在1-10岁,男性比例略高,B-ALL为主;ALL患儿总体预后良好,5年OS及EFS率接近国内水平;危险度分组对预后判断有重要意义,可指导个体化治疗。
Objective To explore the clinical characteristics and prognostic factors of acute lymphoblastic leukemia(ALL)in children.Methods The clinical characteristics and prognostic factors of 132 ALL children admitted to the First Affiliated Hospital of Xinxiang Medical College in the past 10 years were analyzed retrospectively.Kaplan-Meier method was used to evaluate the survival rate.The single factor affecting the prognosis was log-rank test,and the multivariate COX regression model was used to analyze the independent prognostic factors.Results In this group,the ratio of male and female was 1.28∶1,the median age of diagnosis was 5.45 years old,and the onset age was mostly 1-10 years old.The main symptoms at the first diagnosis were fever,pale yellow face,liver,spleen and lymph node enlargement.The main manifestations of peripheral blood picture were increased leukocyte,decreased hemoglobin and thrombocytopenia.B-ALL accounted for 88.64%,T-ALL accounted for 11.36%.Among the detected fusion genes,TEL/AML1 positive accounted for the most common 10.11%,and abnormal karyotype hyperdiploid accounted for the most common 5.38%.The 5-year overall survival(OS)rate of ALL children was(85.82±3.39)%,and the 5-year event-free survival(EFS)rate was(70.80±4.17)%.Univariate prognostic analysis showed that the age at first diagnosis(χ^2=15.65,P=0.00),white blood cell count(χ^2=10.22,P=0.01),karyotype(χ^2=6.48,P=0.04),risk classification(χ^2=27.83,P=0.00)had statistically significant effects on prognosis.Multivariate COX regression analysis showed that the risk classification was an independent risk factor affecting the prognosis(HR:1.76,95%CI:1.02-3.02,P=0.03).Conclusion The incidence age of ALL children is more in 1-10 years old,male is slightly dominant and B-ALL is the main type.The overall prognosis of ALL patients is good,the 5-year OS rate and EFS rate are close to the domestic levels,and the risk classification is of great significance for prognosis judgment,which can guide individualized treatment.
作者
陈茜
李培岭
刘豹
闫彦睿
石太新
CHEN Xi;LI Peiling;LIU Bao;YAN Yanrui;SHI Taixin(Department of Pediatrics,First Affiliated Hospital of Xinxiang Medical College,Henan Weihui 453100,China)
出处
《中国妇幼健康研究》
2020年第10期1368-1373,共6页
Chinese Journal of Woman and Child Health Research
关键词
儿童
急性淋巴细胞白血病
临床特征
预后因素
children
acute lymphoblastic leukemia
clinical characteristics
prognostic factors
作者简介
陈茜(1991-),女,河南新乡人,住院医师,硕士,主要从事小儿血液病研究;通讯作者:石太新,主任医师。
