急性白血病患儿伴中枢神经系统并发症临床特点及危险因素分析
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摘要
目的分析急性白血病(AL)患儿伴中枢神经系统(CNS)并发症的临床特点及危险因素。方法以我院2010-03—2015-03收治的70例急性白血病患儿为研究对象,回顾性分析CNS并发症发生率、CNS并发症临床特点等,同时分析CNS并发症发生危险因素。结果 70例患儿中CNS发生12例(17.14%),其中AML合并CNS者8例,ALL合并CNS者3例,急性淋粒混合细胞白血病1例,CNS并发症以颅内出血为主;血小板计数50×10~9 L~(-1)以下(是、否)CNS并发症发生率分别为50.00%、2.08%,白细胞计数100×10~9 L~(-1)以上(是、否)分别为50.00%、2.08%,淋巴结肿大(是、否)分别为47.62%、4.08%,组内比较差异有统计学意义(P<0.01)。Logistic回归分析发现,血小板计数50×10~9 L~(-1)以下、白细胞计数100×10~9L~(-1)以上、淋巴结肿大是AL伴CNS并发症发生的危险因素。结论急性白血病患儿伴中枢神经系统并发症最常见为颅内出血,且影响CNS并发症发生的危险因素包括血小板计数低、白细胞计数高、合并淋巴结肿大。
Objective To analyze the clinical features and risk factors of children with acute leukemia(AL)complicated with central nervous system(CNS)complications.Methods Seventy children with acute leukemia admitted into our hospital from March 2010 to March 2015 were selected as the research objects.The clinical data of all children were retrospectively analyzed,including the occurrence rate of CNS complications and their clinical features and the risk factors of CNS complications were analyzed at the same time.Results There were 12cases(17.14%)of CNS in 70 cases,including 8cases of AML complicated with CNS,3cases of ALL complicated with CNS and 1case of acute granular lymphocyte leukemia and the complications of CNS mainly were intracranial hemorrhage.The occurrence rates of CNS complications with platelet counts less than 50×10~9 L~(-1)(whether or not)were 50.00% and 2.08%.The rates of white blood cell counts more than 100×10~9 L~(-1)(whether or not)respectively were 50.00%and 2.08%.The rate of lymphadenectasis(whether or not)respectively was 47.62%and 4.08% and there was significant difference between the two groups(P<0.01).Logistic regression analysis showed that less than 50×10~9 L~(-1) of the platelet counts,more than 100×10~9 L~(-1) of white blood cell counts and lymphadenectasis were the risk factors of AL with CNS complications.Conclusion Intracranial hemorrhage is common in children with acute leukemia complicated with central nervous system complications.And the risk factors affecting the occurrence of CNS complications include low platelet count,high white blood cell count and lymphadenectasis.
Objective To analyze the clinical features and risk factors of children with acute leukemia(AL)complicated with central nervous system(CNS)complications.Methods Seventy children with acute leukemia admitted into our hospital from March 2010 to March 2015 were selected as the research objects.The clinical data of all children were retrospectively analyzed,including the occurrence rate of CNS complications and their clinical features and the risk factors of CNS complications were analyzed at the same time.Results There were 12cases(17.14%)of CNS in 70 cases,including 8cases of AML complicated with CNS,3cases of ALL complicated with CNS and 1case of acute granular lymphocyte leukemia and the complications of CNS mainly were intracranial hemorrhage.The occurrence rates of CNS complications with platelet counts less than 50×10~9 L~(-1)(whether or not)were 50.00% and 2.08%.The rates of white blood cell counts more than 100×10~9 L~(-1)(whether or not)respectively were 50.00%and 2.08%.The rate of lymphadenectasis(whether or not)respectively was 47.62%and 4.08% and there was significant difference between the two groups(P<0.01).Logistic regression analysis showed that less than 50×10~9 L~(-1) of the platelet counts,more than 100×10~9 L~(-1) of white blood cell counts and lymphadenectasis were the risk factors of AL with CNS complications.Conclusion Intracranial hemorrhage is common in children with acute leukemia complicated with central nervous system complications.And the risk factors affecting the occurrence of CNS complications include low platelet count,high white blood cell count and lymphadenectasis.
引文
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[7]Yanada M,Matsushita T,Asou N,et al.Severe hemorrhagic complications during remission induction therapy for acute promyeloeytic leukemia:incidence,risk factors,and influence on outcome[J].Eur J Haematol,2007,78(3):213-219.
[2]冯佳,柳金,温娟娟,等.预防性鞘内注射化疗在急性早幼粒细胞白血病中的疗效[J].广东医学,2012,33(19):2 943-2 945.
[3]曲延章,王苏亮,韩英杰,等.中枢神经系统白血病与非中枢神经系统白血病患者脑脊液中基质细胞衍生因子-1α的表达对比[J].中国老年学杂志,2014,34(22):6 295-6 296.
[4]席晓平,刘华胜.纳米微泡载药靶向治疗中枢神经系统白血病的研究进展[J].中国实验血液学杂志,2014,22(3):879-882.
[5]冯洒然,陈子兴,岑建农,等.中枢神经系统白血病小鼠白血病细胞对血脑屏障的破坏作用[J].中华血液学杂志,2011,32(5):289-293.
[5]陈培翠,王婷玉,邹德慧,等.成人急性淋巴细胞白血病复发因素分析及风险度评价[J].中华血液学杂志,2013,34(12):1 050-1 054.
[6]程翼飞,张乐萍,吴珺,等.伴威胁生命的中枢神经系统并发症的急性白血病患儿26例[J].中华实用儿科临床杂志,2013,28(2):131-133.
[7]Yanada M,Matsushita T,Asou N,et al.Severe hemorrhagic complications during remission induction therapy for acute promyeloeytic leukemia:incidence,risk factors,and influence on outcome[J].Eur J Haematol,2007,78(3):213-219.