急性淋巴细胞白血病患儿化疗后合并巨细胞病毒性视网膜炎的临床特点及诊疗预后  

Clinical characteristics and diagnosis,treatment,and prognosis of cytomegalovirus retinitis in children with acute lymphoblastic leukemia after chemotherapy

作　　者：任杰 徐莉 魏志杰 REN Jie;XU Li;WEI Zhijie(Department of Ophthalmology,He Bei Yanda Hospital,Langfang,Hebei,065210,China;Department of Hematology,Hebei Yanda Ludaopei Hospital,Langfang,Hebei,065201,China)

机构地区：[1]河北燕达医院眼科,河北廊坊065210 [2]河北燕达陆道培医院血液科,河北廊坊065201

出　　处：《当代医学》2024年第14期126-129,共4页Contemporary Medicine

摘　　要：目的分析急性淋巴细胞白血病(ALL)患儿化疗后合并巨细胞病毒(CMV)的临床特点及诊疗预后情况。方法回顾性分析2019年6月至2021年12月河北燕达陆道培医院收治的150例ALL化疗后患儿的临床资料,根据是否合并CMV感染分为感染组(n=50)与非感染组(n=100)。分析150例患儿CMV检测结果及临床特征,分析50例ALL合并巨细胞病毒视网膜炎(CMVR)患儿的临床资料及预后情况。结果150例ALL化疗后患儿中合并CMVR者50例,占比为33.33%。感染组年龄小于未感染组,最低血小板值、完全缓解率均低于未感染组,总化疗时长长于未感染组,中危占比高于未感染组,差异有统计学意义(P<0.05)。50例ALL合并CMVR患儿中,76.00%为双眼发病,50.00%为混合型病变,74.00%病变累及≥2个象限,30.00%病变累及黄斑,42.00%出现广泛视网膜血管炎;52.00%经抗CMV治疗后病情稳定。截止随访结束,ALL化疗后合并CMVR患儿共存活47例(94.00%)、死亡3例(6.00%)、复发3例(6.00%),其中早期骨髓复发1例(2.00%)、晚期骨髓复发2例(4.00%);总体生存率为(94.51±4.24)%、无事件生存率为(81.62±8.02)%。结论儿童ALL化疗后合并CMVR后及时进行全身抗病毒治疗,同时对其免疫功能进行检测,针对全身治疗不耐受且不良反应明显者可自玻璃体腔注射抗病毒药物,达到控制患者病情的目的。Objective To analyze the clinical characteristics and diagnosis,treatment,and prognosis of cytomegalovirus(CMV)in children with acute lymphoblastic leukemia(ALL)after chemotherapy.Methods The clinical data of 150 children with ALL treated with chemotherapy at He Bei Yanda Ludaopei Hospital from June 2019 to December 2021 were retrospective analyzed,they were divided into the infected group(n=50)and the uninfected group(n=100)based on whether they had concomitant CMV.The CMV detection results and clinical characteristics of 150 pediatric patients were analyzed,and the clinical data and prognosis of 50 children with ALL complicated with cytomegalovirus retinitis(CMVR)were ana-lyzed.Results Among the 150 children with ALL who underwent chemotherapy,50 cases were complicated with CMVR,accounting for 33.33%.The age in the infected group was less than that in the uninfected group,minimum platelet count and complete remission rate in the infected group were lower than those in the uninfected group,the total chemotherapy duration was longer than that in the uninfected group,proportion of medium risk was higher than that in the uninfected group,and the differences were statistically significant(P<0.05).Among 50 children with ALL complicat-ed with CMVR,76.00%had bilateral lesions,50.00%had mixed lesions,74.00%had lesions involving≥2 quadrants,30.00%had lesions involving the macula,and 42.00%had extensive retinal vasculitis;52.00%of patients showed stable condition after anti CMV treatment.As of the end of followup,a total of 47 cases(94.00%)of ALL patients with concomitant CMVR after chemotherapy survived,3 cases(6.00%)died,and 3 cases(6.00%)relapsed,including 1 case(2.00%)of early bone marrow recurrence and 2 cases(4.00%)of late bone marrow recurrence;the overall survival rate was(94.51±4.24)%,and the event free survival rate was(81.62±8.02)%.Conclusion After chemotherapy for childhood ALL complicated with CMVR,timely systemic antiviral treatment should be carried out,and their immune function should be tested.for tho

关 键 词：急性淋巴细胞白血病 巨细胞病毒性视网膜炎 临床特点 诊疗预后 

分 类 号：R733.71[医药卫生—肿瘤]