急性白血病眼底改变与预后的关系

Correlations of fundus lesions with prognostic significance in acute leukemia

目的确定初诊急性白血病患者视网膜病变与预后的关系，视网膜病变在急性白血病并发症颅内出血（IH）及中枢神经系统白血病（CNSL）中的诊断价值。方法123例急性白血病患者（急性髓性白血病86例和急性淋巴细胞白血病37例）年龄14—77岁。由眼科医生用直接或间接检眼镜在自血病诊断的5d内对视网膜变化进行检查。包括视网膜内出血（IRH），白色中心出血（WCH），棉絮状斑（CWS）。结果有网膜病变者，CNSL和IH的出现比无网膜病变者更常见（分别为27．1％与9．1％，P=0．046；29．2％与9．1％，P=0．029）。完全缓解（CR）率在有IRH表现的患者中比无此改变者减少（52．5％与80．5％，P=0．08），而WCH或CWS的出现与否与CR率无关。结论视网膜内出血的出现提示预后不佳。视网膜损害与颅内出血及中枢神经系统白血病的发生有一定的相关性。

Objective To determine retinal changes in newly diagnosed acute leukemia patients and to evaluate the diagnostic value of retinal findings in patients with central nervous systerm leukemia（CNSL） and intracranial hemorrhage （IH）. Methods 123 patients with acute leukemia（ 86 had myeloid leukemia and 37 had lymphoid leukemia） aged 14-77 years were examined with direct/indirect ophthalmoscopy for the presence of intraretinal hemorrhages （ IRH）, white-centred hemorrhages （WCH） and cotton-wool spots （CWS） within 5 days of diagnosis. Results CNSL and IH were more common in patients with retinopathy than those without （ 27. 1% vs 9. 1%, P = 0. 046 ; 29. 2% vs 9. 1%, P = 0. 029 ;respectively）. Complete remission （CR） rate in patients with IRH was lower than those without （52.5 % vs 80. 5 % ,P = 0. 08）. No association was found between the presence of WCH or CWS and C R rate. Conclusion The present study shows that patients with IRH is an indicator of poor prognosis in acute leukemia. Leukemic retinopathy usually is seen in patients with IH. Invasion of the eye by leukemia is not rare and indicates the need for early ophthalmological examination.