沉淀池法脑脊液细胞学检查在中枢神经系统白血病诊断中的应用

The significance of applying cytological examination of cerebral spinal fluid for diagnosis of central nervous system leukemia

目的通过总结5例中枢神经系统(CNS)白血病患者的脑脊液细胞学结果,观察沉淀池法脑脊液细胞学检查在CNS白血病诊断中的临床意义。方法总结2005年6月至2011年6月间我科明确诊断为CNS白血病的患者5例,分析其临床特点、影像学及脑脊液细胞学结果。结果急性髓性白血病(M2型)1例,急性早幼粒细胞白血病3例,急性髓性白血病(M5型)1例。病程13 d至7年。4例首发症状为头痛、头晕,1例表现为进行性双上肢麻木、疼痛、无力。神经系统查体,2例颈抵抗阳性(+),1例表现为肌力减低,肌肉萎缩,余无特殊表现。3例头颅CT无异常,1例为脑室系统扩张。1例为脑内多发异常信号伴出血信号。沉淀池法脑脊液细胞学检查均可见幼稚细胞,2例流式细胞术检查亦提示CNS白血病。结论 CNS白血病主要累及脑脊膜,沉淀池法脑脊液细胞学检查阳性率较高,对指导临床治疗具有重要意义。

Objective To study the significance of cytological examination of cerebrospinal fluid in diagnosis of central nervous system leukemia,and to summarize the clinical experience in diagnosis of 5 patients with central nervous system leukemia by cytological examination of cerebrospinal fluid.Methods The data of 5 patients diagnosed as central nervous system（CNS）leukemia in this hospital during June 2005 to June 2011 were retrospectively analyzed in order to realize their clinical manifestations,radiographic features and result of cytological examination of cerebrospinal fluid（CSF）.The sedimentary chamber method was applied to obtain cytological specimens of CSF.Results These leukemic patients included 1 case of acute myelogenous leukemia（M2 type）,3 cases of acute promyelocytic leukemia and 1 case of acute myeloid leukemia（M5 type）.The course of disease was 13 days to seven years.Their starting symptoms were headache and dizziness in 4 cases,and progressive numbness,ache and weakness of both upper limbs in 1 case.Neurological examination demonstrated cervical resistance in 2 cases,decrease in muscular strength and muscular atrophy in 1 case,and no other specific manifestations.Cranial CT scanning showed no abnormality in 3 cases,expansion of ventricular system in 1 case,and multiple anomalous signals and bleeding signal in brain of 1 case.There were leukemic cells in CSF with.cytological examination.Flow cytometric examination in 2 cases suggested CNS leukemia.Conclusion CNS leukemia mainly involves leptomeninx,hence cytological examination of CSF with sedimentary chamber method is helpful in diagnosis of CNS leukemia and it is also important in guiding clinical treatment.