培门冬酶致T淋巴母细胞白血病/淋巴瘤患者颅内静脉窦血栓形成的临床诊疗并文献复习  

Clinical diaghosis and treatment of intracranial venous sinus thrombosis induced by pegaspargase in patient with T lymphoblastic leukemia/lymphoma and literature review

作　　者：胡耀嘉 刘淑媚 姚倩 席亚明[2] Hu Yaojia;Liu Shumei;Yao Qian;Xi Yaming(First Clinical Medical College of Lanzhou University,Lanzhou 730000,Gansu Province,China;Department of Hematology,First Hospital of Lanzhou University,Lanzhou 730000,Gansu Province,China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院血液科,兰州730000

出　　处：《国际输血及血液学杂志》2022年第1期51-61,共11页International Journal of Blood Transfusion and Hematology

摘　　要：目的探讨T淋巴母细胞白血病/淋巴瘤(T-ALL/LBL)患者接受培门冬酶(PEG-Asp)治疗期间并发颅内静脉窦血栓形成(CVST)的临床特征、诊断及治疗方法,并进行相关文献复习。方法选择2020年6月2日,于兰州大学第一医院收治的1例PEG-Asp治疗期间发生CVST的23岁男性T-ALL/LBL患者为研究对象。对患者进行病史采集、血常规、骨髓细胞形态学与免疫分型,全身增强CT等检查。根据相关检查结果对患者进行诊断及治疗方案断定。本研究对患者随访截至2021年7月24日。采用回顾性分析方法,对患者的临床表现与诊治过程进行分析。此外,以"门冬酰胺酶""淋巴造血系统恶性肿瘤""颅内静脉窦血栓形成""asparaginase""malignant neoplasm of the lymphohematopoietic system""intracranial venous sinus thrombosis"为中、英文关键词,在中国知网数据库、万方数据服务知识平台、PubMed数据库中检索接受门冬酰胺酶(Asp)治疗后发生CVST的相关文献。文献检索时间为数据库建库至2021年10月20日。总结淋巴造血系统恶性肿瘤患者接受Asp治疗期间发生CVST的临床表现、高危因素及防治等资料。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①病史采集:患者于2020年6月2日因"咳嗽、吞咽困难2个月,加重伴胸痛3 d"入院。根据骨髓细胞形态学与免疫分型,血常规、全身增强CT检查等结果,本例患者被诊断为T-ALL/LBL,于第1、5疗程分别接受PVAP(泼尼松+长春新碱+表柔比星+PEG-Asp)方案诱导缓解治疗和PVA+L(地塞米松+长春新碱+柔红霉素+PEG-Asp)方案巩固治疗。患者化疗后复查骨髓细胞形态学提示骨髓完全缓解(CR),胸部压迫症状缓解、出院。②出院后第3天,患者因"持续头痛3 d伴抽搐3次"再次入院。其血常规检查结果示,白细胞计数(WBC)、血红蛋白(Hb)值、血小板计数、中性粒细胞比例分别为3.03×109/L、102 g/L、44×109/L和85%;凝血功Objective To investigate the clinical features,diagnosis and treatment of T-acute lymphoblastic leukemia/lymphoma(T-ALL/LBL)patients with intracranial venous sinus thrombosis(CVST)during pegaspargase(PEG-Asp)therapy,and review relevant literature.Methods On June 2,2020,one case of T-ALL/LBL patient with CVST during PEG-Asp treatment admitted to First Hospital of Lanzhou University was selected as the research subject.The patient was a 23-year-old male.Medical history was collected,and blood routine,bone marrow cell morphology,immunophenotyping,and whole-body enhanced CT were performed.Diagnosis and treatment of the patient was made according to relevant test results.Patient in this study were followed up until July 24,2021.Clinical manifestations,diagnosis and treatment process of the patient were analyzed retrospectively.In addition,literature related to the occurrence of CVST after asparaginase(Asp)treatment in China National Knowledge Infrastructure database,Wanfang Data Knowledge Service Platform,and PubMed database were searched by key words of"asparaginase""lymphohematopoietic malignant tumor""intracranial venous sinus thrombosis""asparaginase""malignant neoplasm of the lymphohematopoietic system""intracranial venous sinus thrombosis"in Chinese and English.Literature retrieval time was set from inception of each database to October 20,2021.Clinical manifestations,high-risk factors,prevention and treatment data of patients with CVST during Asp treatment of lymphoid hematopoietic malignancy were summarized.This study met requirements of the World Medical Association Declaration of Helsinki revised in 2013.Results①Medical history of the patient:On June 2,2020,the patient was admitted due to"cough and dysphagia for 2 months,aggravated with chest pain for 3 days".The patient was diagnosed as T-ALL/LBL according to results of bone marrow cell morphology and immunophenotyping,blood routine,systemic enhanced CT and other examinations.Then he received PVAP(prednisone+vincristine+epirubicin+PEG-Asp)regimen inductio

关 键 词：前体T细胞淋巴母细胞白血病淋巴瘤 静脉血栓形成 颅内栓塞和血栓形成 窦血栓形成 颅内 血栓溶解疗法 天冬酰胺酶 

分 类 号：R733[医药卫生—肿瘤]