以急性下消化道出血为首发表现的白血病肠浸润肠镜特点

Enteroscopic manifestations of intestinal infiltration affected by leukemic cells from patients with acute lower digestive tract bleeding as the first manifestation

目的 总结以急性下消化道出血为首发表现的白血病细胞肠浸润肠镜特点.方法 对2000年5月至2010年10月入院的3 224例初发白血病中59例以消化道出血为首发表现的患者紧急实施了胃/结肠镜检查,对患者的组织病理学检查结果 ,分子生物学、细胞遗传学检测及临床资料进行回顾性分析,并按出血速度、出血量分为两组.结果 以消化道出血为首发表现者59例（1.83％）.其中急性消化道出血19例（急性出血组）,包括急性下消化道出血13例（12例为急性白血病,1例为淋巴瘤）,占0.40％,急性上消化道出血6例（均为急性髓系白血病）,占0.19％.慢性消化道出血40例（慢性出血组）占0.59％.以消化道出血为首发表现的初发白血病患者中急性白血病人数（76.27％,45/59）明显高于慢性白血病人数（23.73％,14/59）（x2=8.72,P＜ 0.01）.其中急性早幼粒细胞白血病占急性白血病的73.33％（33/45）.结论 以消化道出血为首发表现的白血病患者并不少见,其中急性白血病发病率高于慢性白血病,以急性下消化道出血为首发表现的白血病细胞肠浸润肠镜特点是肠道浸润累及范围广,出血量大,在形态上呈多形性,肠镜表现多样.慢性出血组肠浸润范围较小,可能和凝血机制、血小板功能、血小板数量有关.

Objective To summarize enteroscopic characteristics of intestinal infiltration affected by leukemic cells with acute lower digestive tract bleeding （DTB） as first manifestation.Methods 3 224 firstvisit and hospitalized leukemia patients from May,2000 to October,2010 were retrospected and evaluated.Among them,there were 59 patients with a complaint of DTB as the first manifestation,and they were immediately examined by gastro/enteros copic apparatus after hospitalization,followed by analysis of histopathologic results,molecular biology and cytogenetics and clinical data.They were divided into two groups according to bleeding rate and bleeding volume.Results There were 59 leukemia cases of DTB as an initial symptom with the incidence rate of 1.83 ％ （59/3 224）.Among them,there were 19 cases for acute DTB （acute bleeding group）,consisting of 13 cases （0.40 ％） of acute lower DTB （12 cases for acute leukemia,1 for lymphoma）,and 6 patients （0.19 ％） for acute upper DTB （all for acute myelocytic leukemia）.There were 40patients （0.59 ％） for chronic DTB （chronic bleeding group）.The number of acute leukemia patients （76.27 ％,45/59） was significantly higher than that of chronic leukemia patients （23.73 ％,14/59） among the first-visit leukemia patients with DTB as an initial symptom （x2 =8.72,P ＜ 0.01）.In acute leukemia patients,acute promyelocytic leukemia occupied 73.33 ％ （33/45）.Conclusions Leukemia patients with DTB as the first manifestation are not rare,and the incidence rate of DTB from acute leukemia is higher than that from chronic leukemia.The enteroscopic features of intestinal infiltration affected by leukemic cells from patients with acute lower DTB as the first manifestation show that intestinal infiltrations involved wide-range and big volume bleeding,and present polymorphous with much diversity.But in chronic bleeding group,it is shown that infiltrations involved small-range,which might be related to clotting mechanism,platelet function and count.