982例儿童急性淋巴细胞白血病流行病学研究

目的:分析982例儿童急性淋巴细胞白血病(ALL)临床病例,了解儿童ALL流行病学特征。方法:对本中心2008年4月至2015年5月收治的982例ALL患儿临床资料采用回顾性分析的方法,分析其性别、发病年龄、发病季节、发病相关危险因素及分子生物学特征等。结果:ALL患儿男女比例为1.5∶1,中位发病年龄5岁,发病年龄高峰为2-5岁。发病高峰季节为春季。出生和喂养史分析显示,足月产患儿占98.0%;55.9%患儿是顺产,44.1%患儿是剖腹产。母乳喂养者占79.8%,人工混合喂养儿占20.2%。中位出生体重3.5 kg,其中巨大儿占18.3%。有出生异常史者34例(3.5%),其中脐带绕颈者10例。发病近期有家庭装修史者占31.4%,中位装修环境暴露时间12个月。患儿一至三级亲属中,有血液系统疾病者44例(4.5%),有恶性肿瘤者53例(5.4%)。免疫表型分析结果显示,B-ALL占90.7%,T-ALL占9.3%。分子生物学检测中,TEL/AML1阳性者占21.0%,E2A/PBX1阳性者占5.2%,BCR-ABL阳性者占6.1%,MLL阳性者占2.5%。结论:本研究中儿童急性淋巴细胞白血病男性患儿较多,发病年龄高峰为2-5岁,发病季节高峰为春季,出生季节高峰为秋冬季,剖宫产术分娩、出生时为巨大儿及出生后非母乳喂养比例高于同期全国大部分地区婴儿的均值,有电离辐射及家居环境暴露史与亲属血液病、恶性肿瘤病史者比例较高。

Epidemidogical Analysis of 982 Hospitalized Cases of Childhood Acute Lymphoblastic Leukemia

Objective:To understand the epidemiological characteristics of childhood acute lymphoblastic leukemia(ALL)by analyzing the clinical data of 982 patients.Methods:A retrospective analysis was performed on 982 children with ALL who were admitted to our center from April 2008 to May 2015.The sex,age and season of onset,risk factors related with the disease,and molecular biological characteristics were analyzed.Results:The ratio of male to female in ALL was 1.5∶1,the median age of onset was 5 years old,and the peak age of onset was 2 to 5 years old.The peak season of onset was spring.Analysis of birth and feeding history showed that the children born after normal period of gestation accounted for 98.0%.Among the born children 55.9%of children were born with natural lobour,and 44.1%of children were born by cesarean section.The breast feeding children accounted for 79.8%,while artificial/mixed feeding children accounted for 20.2%.The median birth weight was 3.5 kg(1.8-7.2 kg).There were 34 cases(3.5%)with abnormal birth history,including 10 cases with umbilical cord around the neck.31.4%of the patients had a recent history of house decoration,and the median exposure time to decoration environment was 12 months(1-36 months).Among the first to third grade relatives of the children,44 patients(4.5%)sufferd from blood system diseases,including 23 patients with leukemia,53(5.4%)had malignant tumors,and most of them were lung cancer,digestive system tumors and breast cancer.The immunophenotype showed that B-ALL accounted for 90.7%and T-ALL accounted for 9.3%.In molecular biological tests,TEL/AML1 positive patients accounted for 21.0%,E2 A/PBX1 positive patients accounted for 5.2%,BCRABL positive patients accounted for 6.1%,and MLL positive patients accounted for 2.5%.Conclusion:The childhood ALL occurs in more boys,the peak age of onset is 2-5 years old,the peak season of onset is spring,the peak of birth season is autumn and winter,the proportion of cesarean section,high birth weight and non-breastfeeding after birth are higher than the average value of infants in most parts of the country during the same period.The proportion of childhood ALL patient’s exposure to ionizing radiation and house decoration environment,and relatives with history of blood and malignant tumors are high.