急性早幼粒细胞白血病诱导治疗期并发脑梗塞：一例报告和文献复习

摘要

Objective:To investigate the clinical characteristics of thrombotic complications in acute promyelocytic leukemia(APL)developing during all -trans -retinoic acid(ATRA)therapy.Methods:A 43 -year -woman who presented with uncontrollable increased menstrual volume with massive clots and severe anemia was diagnosed with APL by examination of peripheral blood smear and bone marrow aspirate.ATRA was administered 30mg per day.Re-sults:On day 3 of the ATRA induction treatment,the patient suddenly developed aphasia,confusion and paralysis of the right limbs.Magnetic resonance imaging showed extensive left cerebral infraction,including frontal lobe,temporal lobe,pariet al lobe and occipital lobe.Simultaneous electrocardiogram revealed myocardial ischemia.After combined treatment with arsenic trioxide and idarubicin,patient achieved cytogenetic and molecular remission.Although con-sciousness recovery and aphasia improvement,hemiparesis persisted.Conclusion:Thrombosis complicating ATRA in-duction therapy of APL was a probably life -threatening manifestation.A better knowledge of pathogenetic mecha-nisms of thrombosis is crucial to improve the management and outcome.%目的：研究全反式维 A 酸（all －trans －retinoic acid，ATRA）诱导分化治疗急性早幼粒细胞白血病（a-cute promyelocytic leukemia，APL）时并发广泛脑梗塞的临床特点。方法：对一例以阴道出血和重度贫血为主要表现的患者进行骨髓细胞学、流式免疫分型、染色体和融合基因检查。对神经系统异常进行脑 MRI 检查。对相关文献进行复习。结果：骨髓细胞学、染色体和融合基因检查确诊为 APL。ATRA 治疗后第三天，患者突然出现失语、意识不清和右侧肢体瘫痪。MRI 检查示左侧额、顶、颞和枕叶广泛脑梗塞。心电图和心肌酶谱检查示心肌缺血。经亚砷酸和去甲氧柔红素联合诱导治疗及神经营养等支持治疗后，患者 APL 获完全缓解。意识恢复正常，失语明显改善，但右侧肢体瘫痪未恢复。结论：APL 诱导治疗过程中可合并脑梗塞和心肌梗塞等血栓并发症，需提高认识。