41例合并颅内出血急性白血病尸检临床病理分析

Clinical and Pathological Analysis of 41 Cases of Acute Leukemia Combined with Intracranial Hemorrhage

本研究总结合并颅内出血急性白血病的临床和病理特点。回顾性分析我院1953-1990年剖检的41例合并颅内出血的急性白血病患者临床及病理资料。结果表明:急性髓系白血病35例,急性淋巴细胞白血病6例;白血病临床缓解状态9例,未缓解状态32例;合并高血压病3例,糖尿病2例,败血症4例;白细胞≥100×109/L 19例,血小板<20×109/L 28例,弥散性血管内凝血4例,凝血酶原时间INR≥1.5 10例。病理检查显示,多灶性颅内出血26例,单发颅内出血7例,弥散点状出血8例。检查还显示,41例中共计84个出血灶,其中出血病灶位于脑叶皮质下46个,小脑23个,基底节区6个,桥脑5个,丘脑2个,脊髓2个。结论:颅内出血是导致急性白血病患者死亡的一个主要原因,临床应予重视,综合分析诊治。

This study was aimed to summarize the clinical and pathological features of patients with acute leukemia combined with intracranial hemorrhage. The clinical and pathological data of 41 adult patients diagnosed as acute leukemia in our hospital from 1953 to 1990 year were analyzed retrospectively. The results showed that there were 35 cases of AML,6 cases of ALL; 9 cases in clinical hematologic remission, 32 cases in non-remission, 3 cases of AL with hypertension,2 cases of AL with diabete, 4 cases of AL with sepsis,19 cases with WBC≥100 x 10^9/L; the pathologic examination showed 4 cases of AL acompanied with disseminated intravascular coagulation, 10 cases with prothrombin time INR ≥ 1.5, 26 cases with multifocal intracranial hemorrhage, 7 cases with single intracranial hemorrhage, 8 cases with diffused spotting intracranial hemorrhage; the examination also showed that 84 hemorrhage loci were found in 41 cases of AL, among them 46 foci located under cerebral cortex, 23 foci in cerebelliam, 6 in basal ganglia, 5 foci in pons, 2 foci in thalamus, 2 foci in spinal cord. It is concluded that the intracranial hemorrhage is a major cause resulting in death of AL patients which should be think highly, and the diagnosis and treatment should be conducted through comprehensive analysis.