急性淋巴细胞白血病并中枢神经系统白血病的诊断与治疗  

Diagnosis and therapy for central nervous system leukemia in children with acute lymphoblastic leukemia

作　　者：方建培[1] 徐宏贵[1] 黄绍良[1] 陈纯[1] 

机构地区：[1]中山医科大学孙逸仙纪念医院儿科,广州510120

出　　处：《实用儿科临床杂志》2001年第4期193-195,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的　探讨急性淋巴细胞性白血病 (ALL)并中枢神经系统白血病 (CNSL)的诊断与治疗及影响发病和预后的因素。方法　对 1990～ 1999年收治 117例ALL并CNSL 3 1例临床资料进行回顾分析。结果　CNSL发生距确诊ALL的中位数时间为 8个月 ,高危型组发生率 ( 5 4 .8%)明显高于标危型组 ( 2 3 .7%)。 3 1例CNSL中以脑脊液 (CSF)异常作出诊断远比临床症状多。CNSL治疗效果显示 ,大剂量氨甲喋呤 +三联鞘注 +四氢叶酸钙解救组 (HDMTX +IT +FC)优于阿糖胞苷 +氨甲喋呤 +地塞米松三联鞘注组 (IT) ,与颅脑放疗 +鞘注组 (CR +IT)相当。结论　为避免诊断假阳性造成的过度治疗 ,CSF仅有幼稚细胞而白细胞计数正常者诊断CNSL应慎重 ,HDMTX +IT +FC是治疗CNSL的有效措施。Objectives To investigate the diagnosis, therapy and relative factors of relapse and prognosis in childhood acute leukemia (ALL) with central nervous system leukemia(CNSL).Methods The data of 31 cases of childhood ALL with CNSL in 117 patients hospitalized in our hospital from 1990 to 1999 year were analyzed. Results The mean time of CNSL relapse was 8 months form the confirmation of ALL, and the incidence of high - risk group (54.8 %) was greatly higher than that in the standard- risk group (27.3 %) . In our study, the diagnosis of CNSL made by the abnormity in cerebrospinal fluid(CSF) was much more than by clinical symptoms. The outcome of therapy for CNSL indicated that the regimen of high- dose methotrexate(HDMTX) + CF was more effective than that of intrathecal cytarabine + methotrexate + dexamethasone, and was equal to that of cranial irradiation. Conclusions Only blast in CSF with a normal cell count do not justify diagnosis of CNSL relapse . HDMTX + CF is an effective treatment on CNSL relapse.

关 键 词：急性淋巴细胞白血病 并发症 中枢神经系统白血病 诊断 治疗 

分 类 号：R733.71[医药卫生—肿瘤]