儿童神经母细胞瘤22例临床分析

Clinical analysis of 22 neuroblastoma cases in children

目的分析儿童神经母细胞瘤（NB）的临床及实验室特点，提高诊断率，减少误诊。方法回顾性分析22例NB患儿的临床、实验室特点和误诊原因。结果22例NB患儿临床表现为腿疼15例（68．18％），发热19例（86．36％），贫血20例（90．90％），腹痛、腹胀15例（68．18％），突眼、眼眶瘀斑4例（18．18％）。易出汗20例（90．90％）。原发部位以腹部最多见，为16例（72．72％），原发于纵隔4例（18．18％），原发部位不明2例（9．09％）。实验室特点：血常规以贫血为主20例（90．90％），白细胞减少2例（9．09％），血小板减少3例（13．63％）；尿香草扁桃酸（VMA）阳性率77．77％（14／18）；血清铁蛋白（Fer）增高19例（86．36％），血清乳酸脱氢酶（LDH）增高20例（90．90％），血清神经元特异性烯醇化酶（NSE）增高22例（100．00％）。确诊时已发生转移20例（90．90％）；16例（72．72％）骨髓涂片发现瘤细胞；流式细胞术分析CD56-FITC／CD81-PE／CD45-Perep标记阳性20例（90．90％）。22例患儿中NB误诊率高达54．54％（12／22），被误诊为类风湿疾病4例、消化不良4例、白血病3例、血小板减少症1例。22例NB患儿中CT检查发现病灶20例（90．90％），腹部B型超声发现病灶16例（72．72％）；放射性核素骨扫描检查阳性14例（63．63％）。结论早期行B型超声和CT检查有助于发现NB原发病灶，尿VMA、骨髓涂片、活组织检查、流式细胞术检查可降低误诊率。

Objective To improve the diagnosis rate and decrease misdiagnosis through analyzing the clinical and experimental f^atures of neuroblastoma （NB） in children. Methods The clinical and experimental features associated with the misdiagnosis factors of 22 NB cases were analyzed retrospectively. Results Of the 22 cases, leg pain in 15 cases （68.18 %）, fever in 19 cases （86.36 %）, anemia in 20 cases （90.90 %）, abdominal pain and bloating in 15 cases （68.18 %）, exophthalmoses and bruises eyes in 4 cases （18.18 %） and easily perspire in 20 cases （90.90 %）. Abdomen was the most common primary site founding in 16 cases （accounting for 72.72 %）, followed by mediastinum founding in 4 cases （accounting for 18.18 %）, other sites were 2 cases （9.09 %）. Laboratory results showed that anemia was the most common cause in 20 cases （90.90 %）, oligoleukocythemia in 2 cases （9.09 %） attd less in thrombocytopenia about 3 cases （13.63 %）. Elevated values were recorded in 77.77 % of patients for vanillylmandelic acid （VMA）, 86.36 % for ferritin （Fer）, 90.90 % for lactate dehydrogenase （LDH）, and in 100.00 % for neuron specific enolase （NSE）. 20 cases were found metastasis when diagnosed, which accounted for 90.90 %. 16 cases （72.72 %） were found tumour.cells which determined in bone marrow and 20 cases （90.90 %） were positive for CD56-FITC/CDsrPE/ CD45-Percp by flow cytometry （FCM）. 12 （54.54 %） of 22 NB cases were misdiagnosed for rheumatoid diseases （4 cases）, dyspepsia （4 cases）, leukemia （3 cases） and thrambocytopenia （1 case）. In 22 cases, 20 cases （90.90 %） were positive for CT scan, 16 cases （72.72 %） were positive for abdominal B uhrasonography, and 14 cases （63.63 %） were positive for radionuclide bone scan. Conclusion B ultrasonography and CT scan will contribute to find the primary focus of NB at early stage. VMA, bone marrow smear, biopsy and FCM detection could reduce misdiagnose rate.