Lancet Oncol:儿童感染肠道病毒可以减少白血病风险？！

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研究者进行了一项研究，探究儿童肠道病毒感染后发生白血病的风险。

该研究对NHIRD数据进行了全国性的回顾性队列研究。纳入了＜18岁感染肠病毒的儿童，根据性别、年龄、城市化水平、父母职业、肠道病毒感染年份等按1：1对其匹配非肠病毒感染儿童。研究者仅仅纳入了含有完整信息、至少去过3次诊所诊断为肠病毒感染的儿童。按照第一次诊断为肠病毒感染时间作为起始随访时间。对所有研究对象进行随访，直到发生白血病或失访或退出或直到实验结束。该研究的初始结局指标为随访期间白血病的发生情况。

该研究在2000-1-1至2007-12-31日从NHIRD数据里筛查了3 054 336名小于18岁儿童。纳入282 360名肠病毒感染儿童和 282 355 名对照组儿童。肠病毒感染组白血病发生率为 3.26/100 000人年，对照组为5.84/100 000人-年。肠病毒组白血病发生风险低于对照组 (aSHR0.44, 95% CI 0.31-0.60; p<0.0001)。儿童感染肠病毒可以减少淋巴细胞性白血病风险 (aSHR 0.44, 0.30-0.65; p<0.0001)，减少急性髓性白血病风险 (aSHR 0.40, 0.17-0.97; p=0.04)。在肠病毒感染相关疾病里，疱疹性咽峡炎和手足口病是减少白血病风险的主要疾病。

研究结果表明，儿童肠道病毒感染可以减少白血病风险。该结果支持了白血病病因：Greaves' 延迟感染假说。

来源：MedSci

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Risk of leukaemia in children infected with enterovirus: a nationwide, retrospective, population-based, Taiwanese-registry, cohort study.

Lin JN1, Lin CL2, Lin MC3, Lai CH4, Lin HH4, Yang CH5, Sung FC6, Kao CH7.

BACKGROUND:
The association between enterovirus infections in children and risk of leukaemia is unclear. We aimed to assess the risk of leukaemia after enterovirus infection in children.

METHODS:
We did a nationwide retrospective cohort study by analysing data from the National Health Insurance Research Database (NHIRD) in Taiwan. Children with enterovirus infections aged younger than 18 years were identified. With use of computer-generated random numbers, children not infected with enterovirus were randomly selected and frequency matched (1:1) with children infected with enterovirus by sex, age, urbanisation level, parental occupation, and index year of enterovirus infection. We only included children with complete baseline data for age and sex and who had at least three clinic visits with the diagnosis of enterovirus infection. The diagnosis date of the first clinic visit for the enterovirus infection was defined as the index date for initiation of follow-up person-year measurement and participants. All study patients were followed up until they developed leukaemia, were lost to follow-up, withdrew from the NHI programme, or until the end of the study without leukaemia (censored). Our primary endpoint was a diagnosis of leukaemia during follow-up.

FINDINGS:
Insurance claims data for 3 054 336 children younger than 18 years were randomly selected from all insured children in the NHIRD. We identified 282 360 children infected with enterovirus and 282 355 children not infected with enterovirus between Jan 1, 2000, and Dec 31, 2007. The incidence density rates of leukaemia were 3·26 per 100 000 person-years for the enterovirus-infected and 5·84 per 100 000 person-years for the non-enterovirus-infected cohorts. The risk of leukaemia was significantly lower in the enterovirus-infected cohort than in the non-enterovirus-infected cohort (adjusted subhazard ratio [SHR] 0·44, 95% CI 0·31-0·60; p<0·0001). Children infected with enterovirus have a reduced risk of both lymphocytic leukaemia (adjusted SHR 0·44, 0·30-0·65; p<0·0001) and acute myeloid leukaemia (adjusted SHR 0·40, 0·17-0·97; p=0·04). Herpangina and hand-foot-and-mouth disease were the main diseases associated with the reduced risk of leukaemia.

INTERPRETATION:
The association between enterovirus infection and the reduced risk of developing leukaemia supports Greaves' delayed infection hypothesis for the cause of childhood leukaemia.

http://www.sciencedirect.com/sci ... i/S1470204515000601