儿童急性淋巴细胞白血病发生急性肿瘤溶解综合征的临床分析

摘要

[Objcctivc]To explore the incidence and clinical analysis of acute tumor lysis syndromc(ATLS) in children with acute lymphoblastic lcukcmia(ALL) in order to guide the early prevention and treatment of ATLS. [McthodsJClinical manifestations and data such as biochemical examination of 265 patients with primary ALL before and after chemotherapy were analyzed retrospectively. [RcsultsJAmong 265 ALL children, 60 paticnts(22. 6%) had ATLS including 48 paticnts(80%) with laboratory ATLS and 12 paticnts(20%) with clinical ATLS. Clinical manifestations such as mcdiastinal tumor, splenomegaly, age more than 10 years old, T-ALL immunophenotype, high white blood ccll(WBC) load at onsct(WBCJs50X 109/L) and elevated lactatc dchydrogcnascCLDH^S 1000 U/L) were high risk factors of ATLS. Clinical biochemical features were hy-pcrkalcmia, hypcrphosphatcmia, hypcruriccmia, hypocalccmia, metabolic acidosis and acute renal failure. A-mong ALL patients with ATLS, 5 paticntsd. 89%) died of hypcrkalcmia in a patient, septic shock in a patient and relapse in 3 patients. [Conclusion} ATLS is one of critical complications in pediatric hcmatological malignancies, and has a certain incidence in ALL children. The incidence of laboratory ATLS is higher than that of clinical ATLS, so it should be paid more attention. Complete clinical risk assessment, early biochemical examination and dynamic monitoring during chemotherapy, early diagnosis and treatment of ATLS for primary ALL patients arc the key to reduce the mortality of ALL children in induction remission.%[目的]探讨急性肿瘤溶解综合征(ATLS)在儿童急性淋巴细胞白血病(ALL)中的发病率及临床分析,指导早期预防及治疗ATLS.[方法]回顾性分析265例初发初治ALL患儿的临床表现,化疗前、后血液生化指标等临床资料.[结果]265例ALL患儿中60例(22.6 %)发生ATLS,其中48例(80%)为实验室ATLS,12例(20%)为临床ATLS.临床存在纵隔肿瘤、脾大、年龄≥10岁、免疫表型为T-ALL、发病时高白细胞负荷(白细胞≥50×109/L)、乳酸脱氢酶(LDH)升高≥1000 U/L等表现为ATLS发生的高危因素.临床生化特点表现为高钾血症、高磷血症、高尿酸血症、低钙血症、代谢性酸中毒和急性肾功能衰竭.本组并发ATLS的ALL患儿共死亡5例(1.89%),1例为高钾血症、1例为感染性休克、3例为ALL骨髓复发.[结论]ATLS是儿童恶性血液病比较危急的并发症之一,在ALL患儿中有一定的发病率,且实验室ATLS较临床ATLS发病率高,值得关注.对于初发ALL患儿全面的临床危险度评估,早期完善的血液生化指标检查和化疗过程中的动态监测,早期诊断和治疗ATLS是有效降低ALL患儿诱导缓解期病死率的关键.