Early Infection with Cytomegalovirus and Risk of Childhood Hematologic Malignancies.
Early Infection with Cytomegalovirus and Risk of Childhood Hematologic Malignancies.
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DOI：
10.1158/1055-9965.epi-19-0044
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发表时间：
2019-06
期刊：
影响因子：
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通讯作者：
Feychting M
中科院分区：
文献类型：
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作者：
Wiemels JL;Talbäck M;Francis S;Feychting M
先天性巨细胞病毒（CMV）感染最近被确定为儿童急性淋巴细胞白血病的危险因素，通过检测新生儿血斑中CMV序列的存在。在目前的研究中，我们询问是否可以确定临床上明显的CMV感染之前，血液恶性肿瘤，使用高质量的瑞典人口为基础的登记。CMV感染在患者和医学出生登记处中使用适当的ICD-9或ICD-10代码进行识别，在癌症登记处中确定了15岁以下的儿童恶性肿瘤，其中1987年至2014年在瑞典出生的2，782，507名儿童。观察所有在恶性肿瘤诊断前6个月内登记的CMV感染，校正先天性畸形、变形和染色体异常后，发现血液系统恶性肿瘤CMV相关感染的风险比（HR）增加（HR=11.2，95%CI：5.8-21.5），但中枢神经系统肿瘤没有。较高的CMV发病率被检测到的儿童表面上暴露于母亲CMV感染在怀孕期间与索引儿童。这些数据与先天性CMV感染导致儿童恶性血液病风险增加相一致，但与中枢神经系统肿瘤无关，尽管由于数量较少，需要谨慎解释。
Congenital cytomegalovirus (CMV) infection was recently identified as a risk factor for childhood acute lymphocytic leukemia by detecting the presence of CMV sequences in neonatal blood spots. In the current study, we asked whether clinically apparent CMV infection could be identified prior to hematological malignancy, using high quality Swedish population-based registries. CMV infection was identified with appropriate ICD-9 or ICD-10 codes in the Patient and Medical Birth Registries, and childhood malignancies below the age of 15 were identified in the Cancer Registry, among 2,782,507 children born in Sweden 1987 to 2014. Observing all CMV infections registered earlier than 6 months prior to malignancy diagnosis, an increased hazard ratio (HR) of CMV-related infections, adjusting for congenital malformations, deformations, and chromosome abnormalities, was detected for hematological malignancies (HR=11.2, 95%CI: 5.8–21.5) but not for central nervous system tumors. Higher CMV incidence was detected for children ostensibly exposed through maternal CMV infection during pregnancy with the index child. The data are compatible with a congenital infection of CMV leading to increased risk of childhood hematological malignancies, but not tumors of the central nervous system, although a cautious interpretation is warranted because of the small numbers.