儿童急性淋巴细胞白血病化疗伴发白质脑病的临床特点及远期随访  

Clinical characteristics and long-term follow-up of leukoencephalopathy in pediatric acute lymphoblastic leukemia after chemotherapy

作　　者：褚思嘉 汤继宏[1] 张兵兵[1] 肖潇 杨乐天 徐欢 CHU Sijia;TANG Jihong;ZHANG Bingbing;XIAO Xiao;YANG Letian;XU Huan(Department of Neurology,Children′s Hospital of Soochow University,Suzhou,215025;Department of Child Healthcare,Kunshan Bailu Community Health Services Center,Suzhou,215300,China)

机构地区：[1]苏州大学附属儿童医院神经内科 [2]昆山市柏庐社区卫生服务中心儿童保健科

出　　处：《中国小儿血液与肿瘤杂志》2024年第5期332-336,343,共6页Journal of China Pediatric Blood and Cancer

基　　金：苏州市科技计划(医疗卫生科技创新-临床前沿技术,编号:SKY2022007)。

摘　　要：目的 探讨急性淋巴细胞白血病(ALL)患儿化疗伴发白质脑病的临床特点和远期随访情况。方法 对2013年4月—2023年4月期间在苏州大学附属儿童医院就诊的42例ALL化疗伴发白质脑病患儿的临床资料进行回顾性分析,并通过门诊、电话随访和问卷调研,以全球疾病负担重点控制项目(GBD-DCPP)分级表和执行功能行为评定量表(BRIEF)分别评估患儿的后遗症情况和执行功能受累情况。结果 47.62%ALL患儿确诊白质脑病时出现的神经系统症状主要为癫痫发作、瘫痪、肢体麻木和口齿不清等,头颅MRI异常信号主要分布于侧脑室周围及半卵圆中心、顶叶和额叶等区域。大多数患儿预后情况良好。32例参与后遗症评估,其中3例遗留症状性癫痫,1例注意力缺陷和学习困难。24例参与认知行为中的执行功能评估,9例分量表评分增高。结论 ALL化疗后伴白质脑病患儿的神经系统症状多样、神经影像学病灶分布不一,执行功能有一定程度伤害,总体预后情况良好。Objective The purpose of this study is to investigate the clinical characteristics and long-term follow-up of childhood acute lymphoblastic leukemia(ALL) complicated with leukoencephalopathy(LE) after chemotherapy.Methods Clinical data of 42 pediatric patients with ALL complicated with LE after chemotherapy were retrospectively analyzed.All children were admitted to the Children′s Hospital of Soochow University from April 2013 to April 2023.Through outpatient follow-up,telephone follow-up and questionnaire survey,the sequelae and executive function of patients was evaluated based on scales,such as grading of Global burden of disease-disease control priorities project(GBD-DCPP) and Behavior rating inventory of executive function(BRIEF).Results In 47.62% of the children diagnosed with LE,the neurological symptoms were mainly seizures,paralysis,numbness,slurred speech,etc.The abnormal brain MRI signals were mainly distributed in white matter areas around periventricular area,parietal lobe and frontal lobes.Most children had a good prognosis.The sequelae of thirty-two children were evaluated.Three cases had symptomatic epilepsy,and one case had decreased attention and learning difficulties.Twenty-four children participated in the assessment of executive function(a cognitive behavioral function).Nine children had higher subscale scores.Conclusions ALL children with post-chemotherapy LE have various neurological symptoms and different distribution of neuroimaging lesions,and some degree of executive function damage,but the prognosis is generally good.

关 键 词：白质脑病 急性淋巴细胞白血病 化疗 随访 预后 

分 类 号：R733.71[医药卫生—肿瘤] R747.9[医药卫生—临床医学]