白血病关节炎8例临床分析

Clinical Analysis of Eight Cases of Leukemic Arthritis

目的探讨白血病关节炎(LA)的临床表现及实验室检查特点.为早期诊断提供依据。方法对2002～2006年我院收治的8例 LA 进行回顾性分析,收集整理其临床资料和有关实验室检查结果,分析其发病特点、临床累及的关节特点以及实验室检查特点。结果 8例患者中,2例为青少年,6例为成人;5例为急性淋巴细胞白血病,3例为急性髓系白血病。LA 既可累及多关节,也可累及少关节。最常累及的关节是膝关节,其次是髋关节、腕关节、肩关节、踝关节、骶髂关节、肘关节,也可累及足小关节。LA 受累关节不对称或受累关节症状不对称,关节疼痛较剧烈,对非甾体抗炎药反应差。起病时血常规可以完全正常,也可以有异常.后者主要表现为白细胞计数下降、淋巴细胞比例增高或贫血,血小板正常。红细胞沉降率和 C 反应蛋白均明显异常。类风湿因子阴性,抗核抗体可以阳性。LA 可明显延误白血病的诊断,平均延误时间为4.8(0.5～9)月。结论对于有不明原因的关节痛或关节炎,且对正规治疗反应差的患者,即使血常规正常,也应考虑到白血病的可能,并应进行相关检查。

Objective To investigate the clinical and laboratory characteristics of leukemic arthritis （LA） and to provide basis for early diagnosis of LA. Methods Eight cases of LA in our hospital during 2002-2006 were analyzed retrospectively. Clinical features including initial presentation, involved joints, and laboratory tests were analyzed. Results Among the 8 cases, 2 were children and 6 were adults, 5 patients had acute lymphoid leukemia and 3 had acute myeloid leukemia. LA could be polyarthritis or oligoarthritis. The joints most commonly involved were knee, followed by hip, wrist, shoulder, ankle, sacroiliac, and elbow, as well as small joints in feet. The involved joints were asymmetric. Joint pains were severe and refractory to non-steroidal antinflammatory drugs. The abnormalities of the blood routine test were low white blood cell count, lymphocyteosis, or anemia. The erythrocyte sedimentation rate and C-reactive protein were all abnormal. Serum calcium, phosphate, and alkaline phosphatase were normal. The rheumatoid factor was negative, while anti-nuclear antibody could be negative or positive. LA delayed the diagnosis of leukemia, with an average time of 4.8 （range, 0.5-9） months. Conclusion Patient with arthralgia or arthritis which has undefined cause and poor response to standard management should be considered the possibility of leukemia even when the blood routine is normal. Related examinations should be taken.