儿童急性白血病骨浸润18例临床分析  

Clinical analysis of acute leukemia with bone metastasis in 18 children

作　　者：熊稀霖[1] 黎阳[1] 马磊[1] 方建培[1] 郭海霞[1] 黄科[1] 薛红漫[1] 黄绍良[1] 陈纯[1] 徐宏贵[1] 

机构地区：[1]中山大学孙逸仙纪念医院儿科,广东广州510120

出　　处：《中国实用儿科杂志》2013年第12期921-924,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨儿童急性白血病骨浸润的发病特点、临床表现、实验室检查、影像学表现、治疗及转归。方法采用回顾性分析,对2005年1月至2011年6月中山大学孙逸仙纪念医院儿科血液/肿瘤病区住院的18例急性白血病伴骨浸润患儿的相关资料进行分析。结果急性白血病骨浸润病例占同期住院治疗急性白血病患儿的8.8%;发生骨浸润的18例患儿中,急性淋巴细胞白血病(ALL)12例,免疫学分型均为L2型,其中高危患儿5例,占41.7%;急性非淋巴细胞白血病(ANLL)6例,免疫学分型3例M5、2例M2、1例M6。患儿临床表现为发热、面色苍白、出血为主的白血病症状,仅半数出现骨浸润局部阳性体征。骨浸润部位最多出现在脊髓椎体,以胸椎、腰椎为多,其次为颅骨。所有病例外周血细胞形态均可见大量幼稚细胞,但脑脊液中均未见。血生化检查显示碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)多明显升高。9例ALL伴骨浸润患儿检测融合基因,TEL/AML t(12;21)阳性2例(22.2%),其余7例阴性;2例骨浸润ANLL患儿均为AML1/ETO(8;21)融合基因阳性。所有患儿分别按照不同分型及分级进行化疗,经过一个疗程化疗后再次复查,影像学检查骨浸润病变均有不同程度好转。最终达完全缓解(CR)14例,未缓解1例,死亡1例,放弃治疗2例。结论急性白血病骨浸润临床症状多无特异性,容易误诊及漏诊。结合临床表现、实验室检查及影像学检查方能早期诊断,经化疗后骨浸润基本可好转。治疗原发病是关键,预后与无骨浸润的白血病患儿无明显差异。Objective To investigate the clinical characteristics, clinical manifestations, laboratory tests, imaging find- ings, treatment and outcome of acute leukemia with bone metastasis. Methods A retrospective analysis was made on the 18 pediatric patients＂ clinical materials, who were diagnosed with acute leukemia with bone metastasis admitted to Pediatric Hematology Patch of Sun Yat-sen Memorial Hospital from Jan.2005 to Jun.2011. Results Cases of acute leu- kemia with bone metastasis accounted for only 8.8% of acute leukemia in hospital; it is not a common manifestation of the complications of acute leukemia. Twelve cases of acute leukemia with bone metastasis were acute lymphoblastic leu- kemia （ALL） , all of them were type L2, and five cases were high-risk children, accounting for 41.7% ; other six cases were acute non-lymphocytic leukemia （ANLL）, including three M5 cases, two M2 cases and one M6 case. The main symptom of children＇ s leukemia was fever, pale and bleeding, while only half of bone invasion children had local positive signs. The bone metastasis occurred in the vertebrae most, followed by the skull. Among the bone metastasis in verte- brae, almost all were thoracic and lumbar spine invasion. The peripheral blood cell morphology of all cases showed a large number of leukemic blasts, but their cerebrospinal fluid was negative. The alkaline phosphatase and lactate dehy- drogenase were significantly increased in the majority of these children. Nine cases of ALL with bone metastasis were de- tected fusion genes, TEL / AML t （ 12; 21 ） positive in two cases （22.2%）, while the other seven cases were negative. Both of two ANLL children were AML1/ETO （8;21 ） positive （100%）. All patients were treated by stratifitherapy and the bone lesions had varying degrees of improvement after one course of chemotherapy. At last, 14 of them achieved complete re- mission （CR）, no remission in one case, one died, and two abandoned the treatment. Conclusion The mechanism of acute leukemia with b

关 键 词：急性白血病 骨浸润 儿童 

分 类 号：R72[医药卫生—儿科]