糖皮质激素诱导试验对儿童急性淋巴细胞性白血病早期预后的评价  

Use of glucocorticosteroid induction test to predict the early prognosis of children with acute lymphoblastic leukemia.

作　　者：夏敏[1] 蒋慧[1] 杨静薇[1] 杨为群[1] 陆正华[1] 邵静波[1] 李红[1] 

机构地区：[1]上海交通大学附属儿童医院血液/肿瘤科,上海200040

出　　处：《中国实用儿科杂志》2008年第8期599-601,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的评价儿童急性淋巴细胞性白血病的早期预后。方法对2000年12月至2006年12月于上海交通大学附属儿童医院确诊的急性淋巴细胞性白血病患儿,给予7d的糖皮质激素治疗。根据第8天外周血幼稚细胞动态变化分为激素反应良好组(PGR)和激素反应不良组(PPR),根据两组临床特点和治疗后转归,明确激素诱导试验在评估早期预后中的价值。结果82例患儿中PGR组65例(79%),PPR组17例(21%)。两组初发白细胞计数、危险分型、D19骨髓相差异有统计学意义(P<0.05)。而形态学、免疫分型、染色体,两组间差异无统计学意义。化疗后转归PGR组59例达CCR,2例放弃,3例复发,1例死亡,复发和死亡占4.61%;而在PPR组中8例CCR,1例缓解后行移植治疗,8例复发,其中1例并发脑白,复发率为47.1%,明显高于PGR组。结论糖皮质激素诱导试验是评估儿童急性淋巴细胞性白血病早期预后的一项重要指标。Objective To evaluate the early prognosis of children with acute lymphoblastic leukemia （ ALL ） by using glucocorticosteroid induction test. Methods All children received glucocorticosteroid test for 7 days and were divided into prednison good response （ PGR ） group and prednison poor response （ PPR ） group according to the dynamic changes of the blast cells in the peripheral blood on day 8. Clinical materials were combined to predict the early prognosis. Results Of 82 children,65 children （79 % ） showed prednison good response（ PGR）, 17（21% ） belonged to PPR. White blood count at diagnosis,risk stratification and bone marrow examined on day 19 after treatment were significantly different between PPR and PGR group,while morphology, immunophenotype and chromosome had no significant correlation between the two groups. Of the PGR group,59 patients remained in continuous complete remission （CCR ） ,2 gave up,3 relapsed and one of them died （4. 61% ） ; in the PPR group,8 children in CCR,1 with bone marrow transplantation after complete remission and 8 relapsed, including one with CNS relapse. The relapsed rate of the PPR group was obviously higher than the PGR group. Conclusion The initial response to glucocorticosteroid in children with acute lymphoblastic leukemia is an important factor in predicting the early prognosis.

关 键 词：糖皮质激素 诱导试验 白血病 

分 类 号：R72[医药卫生—儿科]