以骨髓坏死为首发表现急性白血病15例临床分析

Clinical analysis of acute leukemia with the initial manifestation of bone marrow necrosis in 15 cases

目的探讨以骨髓坏死为首发表现的急性白血病（acuteleukemia，AL）患者的临床特征与预后。方法回顾性分析15例以骨髓坏死为首发表现的AL患者的临床资料。结果15例患者主要临床表现为发热、骨痛、贫血、血小板减少等，骨髓检查均可见典型的骨髓造血组织及基质组织坏死；起病至确诊骨髓坏死的中位时间为12d，发现骨髓坏死至确诊AL的中位时间为43d，其中2例诊断骨髓坏死至AL确诊时间2个月以上；治疗后，10例达持续完全缓解，未再出现骨髓坏死；15例随访1～14个月，1a总生存率为64．6％。结论对骨髓坏死患者应高度警惕AL，AL诊治是否及时、有效是影响患者预后的重要因素。

Objective To investigate the clinical characteristics and prognosis of acute leukemia （AL） with the initial manifestation of bone marrow necrosis （BMN）. Methods The clinical data of 15 cases of AL with initial manifestation of BMN were retrospectively analyzed. Results The main clinical manifestations of all patients were fever, bone pain, anemia, or thrombocytopenia at the onset. Bone marrow examination presented typical necrosis of myeloid tissue and medullary stroma. The median time from the onset of symptoms to the diagnosis of BMN was 12 days, and the median time from the diagnosis of BMN to the identification of AL was 43 days. Two cases were identified AL more than 2 months after the diagnosis of BMN. After treatment, 10 patients achieved complete remission and BMN did not occur anymore. All patients were followed up for 1 to 14 months, and the one-year overall survival was 64.6%. Conclusion All patients with BMN should be given keen vigilance for the possibility of developing AL. For AL patients with BMN, the timely diagnosis and effective treatment is the most important factor for the prognosis.