文章：

儿童白血病的感染、免疫反应和病因学

Infection, immune responses and the aetiology of childhood leukaemia

原文发布日期：2006-02-09

DOI: 10.1038/nrc1816

类型: Review Article

开放获取: 否

要点：

1. Childhood leukaemia is the most common paediatric cancer in developed societies.
2. The disease is biologically heterogeneous and no single or exclusive causal mechanism is likely.
3. The natural history of paediatric leukaemia usually involves pre-natal initiation of pre-leukaemic clones (frequently by chromosome translocation) followed by postnatal promotion, secondary mutation and overt disease. Latency after initiation can be very variable (a few months to 15 years).
4. Ionizing radiation is an accepted cause of leukaemia but not a significant cause. Non-ionizing radiation (for example, electromagnetic field radiation) seems to be a very weak or negligible cause.
5. Large, case–control epidemiology studies are required that incorporate biological subtypes of disease and inherited alleles associated with susceptibility. These studies also need to be driven by plausible biological hypotheses.
6. Two infection-based hypotheses have been proposed and assessed: Kinlen's 'population-mixing' hypothesis and Greaves' 'delayed-infection' hypothesis.
7. The body of epidemiological evidence now available is consistent with the view that many childhood leukaemias arise as a consequence of an abnormal immune response to common infection(s), but the mechanisms remain to be determined.

要点翻译：

1. 儿童白血病是发达社会中最常见的儿科癌症。
2. 该疾病在生物学上具有异质性，不太可能存在单一或排他性的致病机制。
3. 儿科白血病的自然史通常涉及产前前白血病克隆的启动（常由染色体易位引发），随后经历产后促进、二次突变及显性发病。启动后的潜伏期可能差异很大（从数月到15年不等）。
4. 电离辐射是公认的白血病诱因，但并非主要诱因。非电离辐射（如电磁场辐射）作为致病因素非常微弱或可忽略不计。
5. 需要开展大规模病例对照流行病学研究，这些研究应整合疾病生物学亚型与遗传易感等位基因，并需以合理的生物学假说为指导。
6. 目前已有两种基于感染的假说被提出并评估：Kinlen的“人群混合”假说和Greaves的“延迟感染”假说。
7. 现有流行病学证据表明，许多儿童白血病是对常见感染产生异常免疫反应的结果，但其具体机制仍有待阐明。

英文摘要：

Childhood leukaemia is the principal subtype of paediatric cancer and, despite success in treatment, its causes remain enigmatic. A plethora of candidate environmental exposures have been proposed, but most lack a biological rationale or consistent epidemiological evidence. Although there might not be a single or exclusive cause, an abnormal immune response to common infection(s) has emerged as a plausible aetiological mechanism.

摘要翻译： 

儿童白血病是儿科癌症的主要亚型，尽管治疗上取得了成功，但其病因仍扑朔迷离。众多环境暴露因素被提出，但大多缺乏生物学依据或一致的流行病学证据。尽管可能不存在单一或唯一病因，对常见感染的异常免疫反应已成为一种合理的致病机制。

原文链接：

Infection, immune responses and the aetiology of childhood leukaemia