临床儿科杂志 ›› 2017, Vol. 35 ›› Issue (5): 336-.doi: 10.3969/j.issn.1000-3606.2017.05.004

• 血液肿瘤疾病专栏 • 上一篇    下一篇

苏州地区白血病儿童人微小病毒B19 感染特点及预后分析

陆叶, 胡绍燕, 何海龙, 刘素香, 孔令军, 范俊杰, 肖佩芳   

  1. 苏州大学附属儿童医院血液科(江苏苏州 215025)
  • 收稿日期:2017-05-15 出版日期:2017-05-15 发布日期:2017-05-15
  • 通讯作者: 胡绍燕 E-mail:hsy139@126 .com
  • 基金资助:
    国家自然基金资助项目(No.81170513,81370627);江苏省临床重点专病项目(No. BL2013014)

Characteristics and prognosis of parvovirus B19 infection in Pediatric leukemia patients in Suzhou

 LU Ye, HU Shaoyan, HE Hailong, LIU Suxiang, KONG Lingjun, FAN Junjie, XIAO Peifang   

  1. Department of Hematology, Children’s Hospital of Soochow University, Suzhou 215025, Jiangsu, China
  • Received:2017-05-15 Online:2017-05-15 Published:2017-05-15

摘要: 目的 分析苏州地区白血病患儿人微小病毒B19(VB19)感染特点和预后。方法 应用聚合酶链反应方法,对收 治的白血病患儿进行VB19定性测定;阳性者予人血丙种球蛋白、更昔洛韦联合中药治疗,根据VB19转阴时间,结合临床 症状、血常规进行疗效评估比较。结果 824例白血病患儿的3 009份标本中,VB19阳性检出36份,阳性率1.2%,涉及患 儿12例,患儿阳性率1.5%。582例急性淋巴细胞白血病患儿中11例阳性,阳性率1.9%;212例急性髓细胞性白血病患儿 中1例VB19阳性,阳性率0.45%。12例检出VB19阳性患儿的病程阶段分别为,初诊3例,早期巩固期2例,延迟强化期4例, 维持化疗期3例。对9例患儿进行疗效评估,治疗敏感4例,持续2例,耐药3例。耐药患儿中2例发生纯红细胞再生障碍性 贫血, 1例经治疗VB19转阴,红系造血恢复; 1例VB19持续阳性,纯红细胞再生障碍性贫血进展。结论 急性淋巴细胞白 血病儿童VB19阳性多见于延迟强化阶段,VB19持续存在可能是导致纯红细胞再生障碍性贫血的重要因素。

Abstract: Objective To explore the effect of parvovirus B19 (VB19) infection on pediatric leukemia patients. Methods The pediatric leukemia patients were enrolled in the study in the Children's Hospital of Soochow University. Expression levels of VB19-DNA-PCR were detected using the polymerase chain reaction. Positive patients would be monitored and treated by conventional treatment as well until VB19 gene became negative. The data was compared according to the VB19 clearance time, clinical symptoms and blood counts to evaluate the effect. Results In the 3009 samples from 824 pediatric leukemia patients, there were 36 samples (1.2%) from 12 cases (1.5%) of pediatric leukemia paients with positive VB19 infection. Among the positive patients, 11 cases (1.9%) were from 582 with acute lymphoblastic leukemia (ALL) patients and 1 (0.45%) was from 212 with acute myeloid leukemia (AML). According to the treatment stage, 3 cases were in initially diagnosed period, 2 cases in early stage of consolidation chemotherapy, 4 cases in delayed enhanced chemotherapy period, and 3 cases in maintenance chemotherapy period. According to the treatment response, 4 cases were in continuous treatment, 2 cases were sensitive to treatment, and 3 cases were drug resistant. In the drug resistance group, 2 cases developed into the pure red cell aplastic anemia (PRCA). After treatment, one was recovered from PRCA with VB19 cleared, the other one remained PRCA with continuously positive VB19. Conclusions More VB19 virus infection in pediatric ALL happened in delayed enhanced chemotherapy period. The persistent presence of VB19 infection on pediatric leukemia patients is closely related with PRCA.