以肾脏损害为首发表现的24例儿童急性淋巴细胞白血病临床分析  

Clinical analysis of 24 cases of pediatric acute lymphoblastic leukemia with renal involvement as the initial manifestation

作　　者：徐甜甜[1] 刘玉峰[1] 魏会霞[1] 魏林林[1] 苏淑芳[1] 李白[1] 毛舒婷 冉玉 Xu Tiantian;Liu Yufeng;Wei Huixia;Wei Linlin;Su Shufang;Li Bai;Mao Shuting;Ran Yu(Department of Pediatric Hematology and Oncology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院小儿血液肿瘤科,450052

出　　处：《中华实用儿科临床杂志》2021年第23期1796-1800,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨以肾脏损害为首发表现的儿童急性淋巴细胞白血病(ALL)的临床特点及远期预后情况,提高临床医师对此类患儿的认识和诊治水平。方法回顾性分析2013年3月至2019年3月郑州大学第一附属医院收治的以肾脏损害为首发表现的24例ALL患儿资料,分析其临床特点,根据肾脏影像学检查分为异常组和正常组,比较2组患儿临床指标的差异,并采用Kaplan-Meier方法评估患儿生存率。结果以肾脏损害为首发表现的ALL患儿占同期初治ALL的2.33%(24/1030例)。其中男20例,女4例,男女比例为5∶1;中位年龄4.3岁(1.3~14.0岁)。浅表淋巴结大16例,肝脾大21例。外周血细胞形态分析可见幼稚细胞15例。肾脏影像学异常9例,化疗后8例恢复正常,1例因肾衰竭死亡。至2020年8月1日随访结束,骨髓复发9例,存活11例,死亡10例,失访3例。异常组(9例)和正常组(15例)在性别、年龄、免疫分型、脏器浸润情况、尿蛋白等方面差异均无统计学意义(均P>0.05)。异常组的高肌酐水平比例及骨髓复发率高于正常组[55.6%(5/9例)比0(0/15例),P=0.003;66.7%(6/9例)比20.0%(3/15例),P=0.036],差异均有统计学意义。生存分析显示,异常组3年累积生存率(17.3%)低于正常组(72.7%),差异有统计学意义(χ^(2)=4.047,P<0.05)。结论对于原因不明的以肾脏损害首发起病的患儿,临床医师应考虑到白血病浸润肾脏首发起病或肾脏起源的淋巴瘤的可能性,注重肝脾淋巴结的查体,送检外周血细胞行形态分析,尽早行骨髓穿刺学检查或肾脏穿刺活检明确诊断;白血病细胞浸润肾脏所致影像学异常可能是ALL患儿的预后不良因素,导致其更易复发且生存率较低。Objective To investigate the clinical features and long-term prognosis of pediatric acute lymphoblastic leukemia(ALL)with renal involvement as the initial manifestation,thus enhancing the diagnostic and therapeutic efficacy.Methods Twenty-four cases of pediatric ALL with renal involvement as the initial manifestation treated in the First Affiliated Hospital of Zhengzhou University from March 2013 to March 2019 were analyzed retrospectively,and their clinical characteristics were analyzed.According to renal imaging examination findings,they were divided into abnormal group and normal group.The differences in clinical features between the two groups were compared,and the cumulative survival rate was evaluated by Kaplan-Meier method.Results Among 1030 newly treated cases of pediatric ALL,24 cases(2.33%)had renal involvement as the initial manifestation,involving 20 males and 4 females,with a male/female ratio of 5∶1 and the median age of 4.3 years(1.3-14.0 years).There were 16 cases of superficial lymph node enlargement and 21 cases of hepatosplenomegaly.Immature cells in peripheral blood were found in 15 cases.Nine cases were examined with abnormal renal imaging,involving 8 cases returned normal after chemotherapy,and 1 died of renal failure.At the end of follow-up on August 1,2020,there were 9 cases of bone marrow relapse,11 survival cases,10 death cases and 3 cases of loss to follow-up.There were no significant differences in the sex,age,immunophenotype,organ infiltration and urinary protein between the two groups(all P>0.05).The proportion of high creatinine level and intramedullary recurrence rate in the abnormal group were significantly higher than those in the normal group[55.6%(5/9 cases)vs.0(0/15 cases),P=0.003;66.7%(6/9 cases)vs.20.0%(3/15 cases),P=0.036].The survival analysis indicated that the 3-year cumulative survival in the abnormal group was significantly lower than that of normal group(17.3%vs.72.7%,χ^(2)=4.047,P<0.05).Conclusions For children with unexplained renal involvement as the initial man

关 键 词：急性淋巴细胞白血病 肾脏损害 浸润 首发表现 预后 

分 类 号：R733.71[医药卫生—肿瘤]