血清铁蛋白水平与儿童急性淋巴细胞白血病预后相关性研究

doi:10.12372/jcp.2022.21e1295

摘要/Abstract

摘要：

目的探索急性淋巴细胞白血病（ALL）患儿体内血清铁蛋白（SF）含量与治疗反应、临床危险度及预后之间的关系。方法收集2014年10月至2021年1月收治的ALL患儿的临床资料,分析SF与治疗反应、临床危险度及预后之间的关系。结果纳入ALL患儿87例,临床危险度为高危的患儿32例。3年无事件生存患儿68例,预后不良患儿19例。与无事件生存组比较,预后不良组的初诊年龄较大,临床危险度为高危的比例较高,SF水平较高,差异有统计学意义（P<0.05）。高危组患儿的平均SF水平为（232.86±64.28）μg/L,高于非高危组（172.73±53.87）μg/L,差异有统计学意义（t=2.78,P<0.001）。巩固治疗前（T3）、维持治疗前（T4）时间点高危组患儿的SF水平显著高于非高危组,差异有统计学意义（P<0.01）。高危组中铁过量组11例、正常组21例。与正常组相比,铁过量组治疗反应差的比例较高,差异有统计学意义（P<0.01）。结论 SF过量与ALL患儿治疗反应差有关,是ALL预后不良的危险因素之一;为改善ALL患儿的治疗效果,建议在化疗期间动态监测SF水平。

关键词: 急性淋巴细胞白血病, 铁蛋白, 治疗反应, 预后

Abstract:

Objective To explore the relationship between serum ferritin (SF) and the treatment response, clinical risk and prognosis in children with acute lymphoblastic leukemia (ALL). Methods Clinical data and SF levels and bone marrow examination at 4 time points, i.e., first diagnosis (T1), before early enhancement (T2), before consolidation therapy (T3), and before maintenance therapy (T4) of 87 children with ALL admitted from October 2014 to January 2021 were collected. Results Among the 87 patients, 68 (78.16%) survived without incident for 3 years, and 19 (21.84%) with poor prognosis; the SF level of children in the poor prognosis group (269.24±79.25) was significantly higher than that of the accident-free survival group (174.06±51.12), and the difference was statistically significant (P <0.05). The average SF level of children in the high-risk group (232.86±64.28) was higher than that of the non-high-risk (low risk and intermediate risk) group (172.73±53.87), and the difference was statistically significant (P<0.01). At T1 and T2, there was no statistically significant difference in SF levels between the high-risk group and the non-high-risk group (P>0.05). But at T3 and T4, the SF level of children in the high-risk group was significantly higher than that of the non-high-risk group, and the difference was statistically significant (P<0.01); At T3 and T4, the SF level of the children in the high-risk group was higher than that of the same group at T1, the difference was statistically significant (P<0.01). High-risk children with high level ferritin were less responsive to treatment than high-risk children with normal ferritin, that is, before maintenance treatment the total number of positive minimal residues, positive fusion genes, recurrences and deaths in the ferritin overdose group (72.72%) was significantly higher than those of ferritin normal group (28.57%), and the difference was statistically significant (P<0.05). Conclusion Ferritin excess is related to poor response to treatment in children with ALL, and it is one of the risk factors for poor prognosis of ALL. In order to improve the treatment effect of children with ALL, it is recommended to dynamically monitor SF levels during chemotherapy.

Key words: acute lymphoblastic leukemia, ferritin, treatment response, prognosis

刘玉, 岳迎宾, 严媚. 血清铁蛋白水平与儿童急性淋巴细胞白血病预后相关性研究[J]. 临床儿科杂志, 2022, 40(2): 113-117.

LIU Yu, YUE Yingbin, YAN Mei. Correlation between serum ferritin level and prognosis of childhood acute lymphoblastic leukemia[J]. Journal of Clinical Pediatrics, 2022, 40(2): 113-117.

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项目	无事件生存组(n=68)	预后不良组(n=19)	统计量	P
男[n(%)]	36(52.9)	9(47.4)	χ²=0.19	0.670
初诊年龄(x±s)/岁	4.7±1.6	6.1±1.5	t=4.11	<0.001
临床危险度[n(%)]			χ²=4.66	0.031
非高危	47(69.1)	8(42.1)
高危	21(30.9)	11(57.9)
SF(x±s)/μg·L^-1	174.1±51.1	269.2±79.3	t=3.93	<0.001

时间点	非高危组(n=55)	高危组(n=32)	t值	P
T1	167.5±44.8	172.6±54.3	0.31	0.761
T2	163.3±48.0	172.8±60.8	0.53	0.603
T3	166.3±51.8	225.8±72.4	2.69	<0.001
T4	193.9±62.0	360.2±88.3	4.06	<0.001
F值	1.71	3.70
P	0.154	0.067

项目	正常组(n=21)	铁过量组(n=11)	统计量	P
男[n(%)]	10（47.6）	6（54.6）	-	0.714¹⁾
年龄(x±s)/岁	6.2±2.0	6.2±1.9	t=0.04	0.970
免疫分型(B系)[n(%)]^2）	14（66.7）	8（72.7）	-	0.531¹⁾
细胞遗传学异常[n(%)]	4（19.1）	3（27.3）	-	0.463¹⁾
分子生物学异常[n(%)]	6（28.6）	4（36.4）	-	0.471¹⁾
治疗反应差[n(%)]	6（28.6）	8（72.7）	-	<0.001¹⁾
MRD持续阳性[n(%)]	1（4.8）	1（9.1）	-	1.000¹⁾
融合基因持续阳性[n(%)]	1（4.8）	2（18.2）	-	0.266¹⁾
复发+死亡[n(%)]	4（19.0）	5（45.5）	-	0.213¹⁾