以AKI为首发症状的儿童NHL五例并文献复习  

Acute kidney injury as the first presentation of pediatric non-Hodgkin lymphoma: a report of five cases and literature review

作　　者：姚强华[1] 方营旗[1] 刘玉峰[1] 

机构地区：[1]郑州大学第一附属医院儿科,郑州450052

出　　处：《新医学》2018年第1期57-61,共5页Journal of New Medicine

摘　　要：目的提高对以急性肾损伤(AKI)为首发症状的儿童非霍奇金淋巴瘤(NHL)诊治特点的认识。方法对5例以AKI为首发症状的NHL患儿的临床资料进行分析,并以"肾损伤""非霍奇金淋巴瘤"及"儿童"或"kidney injury""non-Hodgkin lymphoma"及"child/children/childhood"为检索词,对Pub Med、中国期刊全文数据库、万方数据知识服务平台、维普中文科技期刊数据库进行检索,收集并分析检索到的以AKI为首发症状的NHL患儿的临床资料。结果 5例患儿均为男性,年龄1~14岁,均因出现全身或肢体水肿入院。5例血清乳酸脱氢酶(LDH)、血尿酸、血肌酐均偏高,2例出现蛋白尿,1例出现少尿[<250 ml/(m^2·d)]。5例行彩色多普勒超声检查均示双肾肿大。5例均行骨髓穿刺确诊NHL。5例均采用中国儿童肿瘤协作组-B细胞NHL-2010化学治疗方案治疗,均发生了急性肿瘤溶解综合征(TLS)。随访6~24个月,存活2例,3例因早期并发症或完全缓解后复发死亡。文献检索到的5例患儿中男2例、女3例,年龄2.5~14岁,其中有血尿1例,蛋白尿3例,2例LDH明显升高,均伴有双肾肿大,均通过肾脏穿刺确诊。接受化学治疗的3例中2例发生了急性TLS,至末次随访时均无病生存,另2例因疾病进展死亡。结论以AKI为首发症状的NHL患儿双肾肿大明显但尿检改变轻微,多伴有LDH明显升高,对该类患儿应尽早行骨髓穿刺或肾脏穿刺协助诊断。NHL累及肾脏时易导致急性TLS的发生,应积极预防,必要时需降低化学治疗强度。Objective To deepen the understanding of diagnosis and treatment of pediatric nonHodgkin lymphoma( NHL) with acute kidney injury( AKI) as the first presentation. Methods Clinical data of 5 NHL children with AKI as the first presentation were analyzed. Literature review was performed from Pub Med,CNKI,Wanfang database and Chongqing Vip database by using the keywords of "kidney injury","non-Hodgkin lymphoma"and"child/children/childhood"in both English and Chinese. Clinical data of the retrieved NHL children with AKI as the first presentation were collected and analyzed. Results Five male children were aged 1-14 years and hospitalized due to systemic or limb edema. Five cases presented with relatively high levels of serum lactate dehydrogenase( LDH),blood uric acid and serum creatinine,two had albuminuria and one child presented with uropenia < 250 ml/( m^2·d). Color doppler ultrasound( color ultrasound) of 5 cases revealed bilateral kidney enlargement. Five children were diagnosed with NHL by bone marrow puncture. All 5 children were treated with Chinese Children Cancer Group-B cell-non-Hodgkin Lymphoma2010 protocol and presented with acute tumor lysis syndrome( TLS). The follow-up endured from 6 to 24 months. Two cases survived and the remaining 3 children died from early complications or recurrence after complete response. Five NHL children with AKI were searched from all databases,2 cases were male and 3 female,aged 2. 5-14 years. One case presented with hematuria,3 with albuminuria and 2 with significant elevation of LDH. All cases were accompanied by bilateral kidney enlargement. The diagnosis of NHL was finally confirmed by kidney puncture. Among 3 children receiving chemotherapy,2 cases suffered from acute TLS and obtained disease-free survival until the final follow-up. Another 2 children died from disease progression. Conclusions NHL children with AKI as the first presentation are manifested with significant bilateral kidney enlargement. However,urine test reveals slight changes,primarily accompanied by s

关 键 词：非霍奇金淋巴瘤 急性肾损伤 肿瘤溶解综合征 儿童 

分 类 号：R733.1[医药卫生—肿瘤]