儿童白血病中枢神经系统并发症CT和磁共振影像表现及其与血清生长分化因子15及骨桥蛋白的相关性研究  

Study on the CT and MRI features of CNSCL in childhood with leukemia and the correlation of that with serum GDF-15 and OPN

作　　者：朱振国[1] 郭雪梅 姜熳[1] 张倩倩 ZHU Zhen-guo;GUO Xue-mei;JIANG Man(不详;Information Data Center,Jiangsu Provincial Hospital of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]江苏省中医院信息数据中心,江苏南京210029 [2]南京医科大学附属儿童医院血液肿瘤科,江苏南京210008

出　　处：《中国医学装备》2023年第9期50-55,共6页China Medical Equipment

基　　金：江苏省重点研究与开发计划(190410804045)“CT联合MRI在儿童白血病中枢神经系统并发症中的诊断作用”。

摘　　要：目的:观测儿童白血病中枢神经系统并发症(CNSCL)CT及磁共振成像(MRI)影像表现,并分析其与血清生长分化因子15(GDF-15)及骨桥蛋白(OPN)的相关性。方法:选取医院收治的疑似出现CNSCL的156例白血病患儿,均行CT及MRI检查,根据患儿临床表现、影像学及脑脊液检查明确是否存在CNSCL。观察存在CNSCL患儿的影像学表现;对比并发CNSCL及未并发CNSCL患儿的GDF-15及OPN的差异,并评估二者对并发CNSCL的预测价值;分析GDF-15及OPN与不同类型CNSCL的相关性。结果:在156例患儿中,有40例并发脑出血患儿,其中多数患儿为多发血肿和(或)微出血病灶;10例并发脑梗死的患儿中,CT下可见基底节区及额顶叶低密度影;32例并发硬脑膜浸润患儿及5例硬脑膜浸润伴颅骨浸润中,病灶在CT下呈高密度影;3例并发脑实质浸润的患儿中,CT下呈高密度肿块,未见明显的占位现象,周围脑实质可见水肿;3例并发脑白质病变患儿中,CT无明显异常;2例并发二次肿瘤的患儿中,均为脑干胶质瘤,CT下未见明显异常。发生CNSCL的患儿血清GDF-15及OPN水平明显高于未发生CNSCL的患儿,差异有统计学意义(t=25.934,t=20.234;P<0.05)。患儿中血清OPN高水平者与低水平者相比,并发脑出血的风险增高,差异具有统计学意义。(x^(2)=11.862,P<0.05)。结论:白血病患儿血清OPN及GDF-15水平对其是否并发CNSCL具有一定的预测价值;在一定范围内,患儿血清OPN水平越高越容易并发脑出血。Objective:To observe the CT and MRI features of central nervous system complications of leukemia(CNSCL)in children with leukemia,and analyze the correlation of that with serum growth differentiation factor 15(GDF-15)and osteopontin(OPN).Methods:A total of 156 children with leukemia who were suspected to have CNSCL admitted to the hospital were selected and they underwent CT and MRI.According to clinical manifestation,imaging and cerebrospinal fluid examination of pediatric patient,it was confirmed whether there was CNSCL in these pediatric patients.The imaging manifestations of children with CNSCL were observed.The differences of serum GDF-15 and OPN between pediatric patient with CNSCL and pediatric patient without CNSCL were compared,and the predictive values of GDF-15 and OPN for CNSCL were assessed.In addition,the correlations of GDF-15 and OPN with different types of CNSCL were further analyzed.Results:In 156 pediatric patients,40 children complicated cerebral hemorrhage,and most of them had multiple hematomas and/or microhemorrhagic lesions.In 10 pediatric patients with cerebral infarction,the low-density shadows at the basal ganglia and frontoparietal lobes were showed under computed tomography(CT).In 32 cases who complicated dural infiltration and 5 cases who complicated dural infiltration with skull infiltration,the lesions showed high-density shadows under CT.In 3 pediatric children who complicated brain parenchymal infiltration,the CT results showed high-density masses without obvious occupancy,and the peripheral brain parenchyma appeared edema.In the 3 pediatric children complicated white matter lesions,there was no obvious abnormality in the CT results.In the 2 pediatric children who complicated secondary tumors,all of them were brainstem gliomas,and there was no obvious abnormality in CT results.Compared with pediatric children without CNSCL,the serum levels of GDF-15 and OPN in pediatric children with CNSCL were significantly higher,and the differences of these between them were significant(t=25.93

关 键 词：白血病 中枢神经系统并发症(CNSCL) 影像学表现 生长分化因子-15 骨桥蛋白 

分 类 号：R816.1[医药卫生—放射医学]