儿童急性淋巴细胞白血病52例临床和预后因素分析  

Clinical and prognosis study on 52 children with acute lymphoblastic leukemia

作　　者：王宁玲[1] 刘芝璋[1] 刘红军[1] 张爱梅[1] 李春[1] 

机构地区：[1]安徽医科大学附属安徽省立医院,安徽合肥230001

出　　处：《儿科药学杂志》2008年第1期19-22,共4页Journal of Pediatric Pharmacy

摘　　要：目的:通过对我科收治的急性淋巴细胞白血病(ALL)患儿52例进行相应检测评估和分析,旨在进一步总结经验、吸取教训、以便进一步加强儿童ALL的诊断和治疗,提高儿童ALL的无病生存率(DFS)和治愈率。方法:收集2000年1月至2004年9月收治并坚持正规化疗的52例儿童ALL的临床和实验室资料,ALL包括中枢神经系统白血病(CNSL)及睾丸白血病(TL)的诊断参照荣成方案,对CNSL的诊断加做脑脊液微小残留病(MRD)的检测。结果:本组患儿SR-ALL61.54%(32例)、HR-ALL28.46%(20例)。L1型44.23%(23例)、L2型42.31%(22例)、L3型13.46%(7例);免疫分型中B-ALL占86.54%(45例)、T-ALL占13.46%(7例)、合并髓系表达9.16%(5例)。具有1项及其以上染色体数目或结构异常的患儿标本占28.89%(15例),其中Ph染色体2例、t(4;11)1例、<46条亚二倍体染色体3例。所有患儿接受泼尼松敏感试验,不敏感13.46%(7例)。外周血WBC>50×109/L占19.23%(10例),金标准确诊为CNSL5例。从CR后到进入维持治疗期间复发11例、停药后复发3例;在复发的14例中骨髓复发7例,CNSL复发6例,TL复发1例,复发率为26.92%,总的DFS至目前为止为73.08%。结论:本组ALL患儿初诊时临床表现较重,初诊时高白细胞计数、泼尼松诱导试验不良、Ph染色体阳性以及初诊时合并CNSL是预后不良因素,其中泼尼松诱导不良较之白血病其他生物学和临床特征更具预后价值。坚持规范的诊断和治疗是决定预后的重要因素。Objective：To help enhance the diagnosis and treatment of child ALL and increase its DFS and cure rate, the evaluation and analysis were done on the 52 ALL patients treated in our department. Methods：52 ALL patients from Jan 2000 to Sep 2004 were enrolled in this study. The diagnoses including CNSL and TL were done and the chemotherapy regimen was used according to the protocal （ suggested by the Pediatric Hematology Group of China Medical Association in 1999）. MILD in CSF was also done for CNSL. Results：In this study SRALL accounted for 61.54% and HR-ALL for 28.46% from clinical risk elassifieation, The patient with B-ALL and T-ALL aeeountod for 86.54% and 13.46% respectively. B-ALL/T-ALL with my antigen expression accounted for 9. 16%. 28.89% bone marrow samples showed the chromosome number and/or structure abnormalities, 13.46% of the patients showed bad response to prednisone used in all patients. High WBC count accounted for 19.23%. And there were 5 patients with CNSL diagnosed with gold stantards. 14 patients had repissed and DFS at this stage was 73.08%. Conclusions：The clinical manifestations in preliminary diagnosis were more severe than in those after. Poor prognosis included high WBC count at diagnosis,bad response to prednisone,Ph-ehromsome and CNSL,espeeially bad response to prednisone. Insistent and formal chemotherapy is the most important factor in this study.

关 键 词：急性淋巴细胞白血病 儿童 MIC分型 治疗 预后因素 

分 类 号：R969.1[医药卫生—药理学]