甲氨蝶呤诱发急性淋巴细胞白血病患儿急性脑病7例临床与影像学特点分析

摘要

目的 探讨急性淋巴细胞白血病(ALL)儿童因使用甲氨蝶呤(MTX)出现的急性脑病的临床及影像学特点.方法 2005-07-01-2009-08-31首都医科大学附属北京儿童医院血液病中心收治的ALL患儿637例,回顾性分析应用MTX后发生急性脑病病例的临床和影像学资料.结果 7例患儿应用MTX后3～10d发生急性脑病,主要表现为偏瘫、全身抽搐、言语不利、单侧肢体无力和面瘫,予对症治疗后3～5d内缓解.急性脑病的发生与MTX剂量、患儿年龄和MTX代谢有关.4例患儿弥散加权成像(DWI)表现为深部白质的弥散受限,以半卵圆中心和放射冠区为著.结论 MTX诱发的急性脑病主要表现为一过性、局灶性运动功能损害,DWI的弥散受限是MTX诱发急性脑病诊断的敏感手段.%Objective To investigate the clinical and radiological features of methotrexate (MTX) -induced acute encephalopathy in children with acute lymphoblastic leukemia (ALL). Methods We reviewed clinical and radiological dtta of this complication in childhood acute lymphoblastic leukemia treated from July 1, 2005 to August 31, 2009 in Beijing Children Hospital. Results Seven patients experienced acute encephalopathy within 3 ~ 10 days after receiving high-dose I.v. And/or intrathecal MTX. The signs and symptoms varied at presentation: hemiparesis,dysphasia,seizure, weakness and facial palsy. All patients recovered after 3 ~ 5 days. Acute enoephalopathy occurred associated with the dosage of MTX, the age of the patients and MTX metabolism. Four patients had restricted diffusion by diffusion-weighted image (DW1) in the deep white matter, esp. Centrum semiovale and corona radiate. Conclusion Acute MTX encephalopathy often manifests transient and focal motor function deficit. Restricted diffusion on DWI is a sensitive sign of acute MTX encephalopathy.