急性白血病中枢神经系统受累的诊治  

Diagnosis and treatment of acute leukemia with central nervous system infiltration

作　　者：佟红艳[1] 

机构地区：[1]浙江大学医学院附属第一医院血液科,杭州310003

出　　处：《中国实用内科杂志》2011年第12期921-923,共3页Chinese Journal of Practical Internal Medicine

摘　　要：急性白血病(AL)中枢神经系统受累,称中枢神经系统白血病(CNSL),发生在AL任何时期,以急性淋巴细胞白血病(ALL)居高。初发时高白细胞计数、有明显髓外侵润、某些类型如M4、M5a、T细胞型、成熟Burkitt型、复发M3及有t(4;11)、Ph+遗传学特征都是CNSL高危发病因素。脑脊液(CSF)涂片中找到白血病细胞最具诊断意义。CSF白细胞>5个/μL,伴有CNS异常表现即可诊断CNSL。对CSF进一步分类有助于ALL分层治疗。CNSL治疗重在预防,常用的防治方法有鞘内化疗、全身系统治疗以及放射治疗。现代治疗模式不再强调放疗的作用,中大剂量化疗药物的早期使用可有效防治CNSL。Sununary：Acute leukemia （AL） with central nervous system （CNS）involvement, known as central nervous system leukemia （CNSL） ,can occur at any stage of AL. Acute lymphocytic leukemia is the most common type of leukemia with CNS involvement. There are several high risk factors associated with occurrence of CNSL,including hyperleukocytosis at diagnosis, presence of extramedullmT infiltration, some types of AL like acute myelomonocytic leukemia, acute monocytic leukemia （M5a）, T-cell immunophenotype, Burkitt＇s lymphoma （mature）, relapsed a- cute promyelocytic leukemia,high-risk genetic abnormalities such as t （4;11 ） and the Philadelphia chromosome. The presence of leukemic ceils in cerebrospinal fluid （CSF） has important diagnostic value. Patients with a CSF sample that contains WBC more than 5/μL and with abnormal symptoms or signs of CNS can be diagnosed as CNSL. Classification of CSF is useful in stratified therapy for CNSL. The key to CNSL therapy is prophylaxis, which consists of intrathecal chemotherapy, systemic chemotherapy and radiation therapy. The role of radiation therapy has no longer been emphasized in modern therapy modes. Early chemotherapy in moderate or high dose can effectively prevent and treat CNSL.

关 键 词：急性白血病 中枢神经系统 

分 类 号：R557[医药卫生—血液循环系统疾病]