骨髓转移癌致骨髓坏死一例并文献复习

Malignant with bone marrow necrosis：a case report and literature review

目的：探讨骨髓坏死（bone marrow necrosis，BMN）的病因、临床表现、实验室检查特点及预后。方法对确诊的1例骨髓坏死患者的临床资料结合文献进行分析。结果该例患者外周血血红蛋白（HGB）36 g／L，血小板（PLT）17×109／L；生化指标中乳酸脱氢酶（LDH）1454．9 U ／L，碱性磷酸酶（ALP）1319．4 U ／L；骨髓涂片提示骨髓坏死，骨髓活检考虑为骨髓转移癌，倾向腺癌，骨髓广泛坏死。结论BMN 主要由恶性肿瘤、严重感染、药物等引起，主要表现为骨痛、发热、血细胞进行性下降、LDH 和 ALP 增高，发病率低，预后极差。为延长此类患者生存期，关键在于早发现、早诊断和对原发病的早治疗。

Objective To investigate the pathogenesis,clinical feature,laboratory examination characteristics and the prognosis of the bone marrow necrosis.Methods To analyze the clinical data of one case of diagnostic bone marrow necrosis and review the relevant literature.Results The peripheral blood examinations were as follows：the hemoglobin（HGB）level was 36g/L,platelet count was 17 ×109 /L.The biochemistry tests showed that lactate dehydro genase （LDH）was 1 454.9U /L and alkaline phosphatase（ALP）was 1 319.4U /L.Bone marrow necrosis was detected by bone marrow smear.Bone marrow biopsy was considered as a bone marrow metastatic carcinoma,which was prone to adenocarcinoma.Conclusion The bone marrow necrosis is mainly caused by the cancer,the serious infection and the drug.Its main performances were bone pain,fever,progressive decline in bloods cells,the LDH and ALP increasing and poor prognosis.In order to extend the lifetime of this kind of patients,the key lies in the early detection,the early diagnosis,and the early treatment of its primary diseases.