儿童结核病合并恶性血液病七例临床分析  

Clinical analysis of 7 cases of pediatric tuberculosis with hematological malignancy

作　　者：李涛[1,2] 席秀红[1] 李锋[1] 刘旭晖[1] 蒋慧[3] 卢水华[1] 

机构地区：[1]上海市公共卫生临床中心结核科,201508 [2]复旦大学附属华山医院感染科 [3]上海交通大学附属儿童医院血液科

出　　处：《中国防痨杂志》2014年第12期1021-1024,共4页Chinese Journal of Antituberculosis

摘　　要：目的探讨儿童结核病合并恶性血液病的临床特点、诊断、治疗和预后。方法收集2010年4月至2014年9月在上海市公共卫生临床中心诊断的儿童结核病合并恶性血液病7例，包括急性淋巴细胞白血病6例，胸膜恶性淋巴瘤I例；其中男5例，女2例，年龄3～11岁，中位年龄8岁。分析7例患儿的临床特点、诊断方法、治疗和预后。结果7例结核病合并恶性血液病患儿中，2例结核病诊断先于恶性血液病，5例在白血病化疗过程中出现肺结核症状。7例患儿均出现高热、盗汗及肝脾肿大，咳嗽6例，消瘦5例，食欲减退5例，呼吸困难2例，骨关节痛1例（肘关节），浅表淋巴结肿大2例。干扰素释放试验阳性5例。7例结核病患儿均获得病原学确诊并接受个体化治疗方案进行抗结核化疗，其中5例联合抗白血病药物治疗，2例（I例合并急性淋巴细胞白血病，1例合并恶性淋巴瘤）最后放弃血液病化疗。随访发现2例放弃化疗的患儿均死亡，其他5例结核病合并急性淋巴细胞白血病患儿结核病均治愈，其中3例急性淋巴细胞白血病患儿至今均为持续完全缓解状态，1例刚结束白血病维持化疗，另i例患儿仍在维持化疗阶段。结论儿童结核病合并恶性血液病患儿的诊断是难点，积极进行抗结核、白血病联合化疗，儿童结核病合并急性淋巴细胞白血病仍可以取得较好的抗结核病疗效，且不影响血液病化疗。Objective To explore the clinical characteristics, diagnosis, treatment and prognosis of pediatric tuberculosis （TB） with hematological malignancy. Methods A retrospective study was performed on 7 children diagnosed with tuberculosis and hematological malignancy（including 6 cases of acute lymphoblastic leukemia and 1 of pleural lymphoma, 5 were male and 2 were female; the median age was 8 years old ranging from 3 years to H years） at Shanghai Public Health Clinical Center from April 2010 to September 2014. The diagnosis, clinical features, treatment and prognosis were evaluated. Results Of the 7 patients, 6 children had acute lymphoblastic leukemia, and 1 had pleural lymphoma. Two of all patients were diagnosed TB before hematological malignancy, 5 patients during acute lymphoblastic leukemia chemotherapy. Clinical manifestations included fever, night sweats and hepato- splenomegaly in all cases, cough in 6 cases, losing weight and loss of appetite in 5 cases, joint pain in 1 case, breathing difficulty and superficial lymphadenopathy in 2 cases. IGRA was positive only in 5 patients （5/7）. Anti- tuberculosis combined with chemotherapy was applied to 5 cases, and 2 cases gived up treatments, including 1 case of acute lymphoblastic leukemia and 1 of pleural lymphoma. During follow-up,2 case who gived up treatment died, other 5 patients showed tuberculosis cured,and 3 of 5 patients completed leukemia treatment and achieved continu- ous complete remission（they were in CCR for 3 years, 18 months and 6 months, respectively）, 1 of the 5 patients just completed maintenance treatment, and 1 patient was still in maintenance treatment for leukernia. Conclusion Early diagnosis of children TB combined hematological malignancy remains a challenge for clinicians, and anti-tuberculosis combined with chemotherapy is required that this isn＇t going to affect their prognosis.

关 键 词：结核 血液肿瘤 儿童 

分 类 号：R529.9[医药卫生—内科学]