分化综合征胸部CT表现

The Chest CT Imaging of Differentiation Syndrome

目的探讨全反式维甲酸(ATRA)和/或亚砷酸治疗急性早幼粒细胞白血病(APL)所致分化综合征(DS)患者的临床及胸部影像学表现特征。方法对安庆市立医院2013年11月至2016年8月行ATRA和/或亚砷酸诱导治疗的11例APL并发DS患者的临床表现及胸部CT特征进行回顾性分析。结果 11例DS患者中,出现呼吸困难7例,发热8例,下肢水肿5例,体重增加3例,低血压1例。胸部CT显示两肺弥漫分布的斑片状及磨玻璃样高密度影10例,两侧胸腔积液11例,心包积液10例。结论 DS易发展为急性呼吸窘迫综合征,病死率高,影像科医师通过分析其胸部CT表现,争取早期识别DS,协助临床快速启用合理的治疗方案,改善预后,降低患者死亡率。

Objective To study clinical and chest imaging characteristics of the differentiation syndrome in acute promyelocytic leukemia（APL） patients treated with all-trans retinoic acid（ATRA） and/or arsenite. Methods The clinical and chest CT manifestations of 11 APL patients with differentiation syndrome from November 2013 to August 2016 in Anqing Municipal Hospital,who were treated by ATRA and/or arsenite,were retrospectively analyzed. Results Among 11 patients with differentiation syndrome,7 patients（63. 6%） had dyspnea,8 patients（72. 7%） had fever,5 patients（45.5%） had lower-extremity edema,3 patients（27. 3%） had weight gain and 1 patient（9. 1%） hypotension. Patchy groundglass opacity distributed in both lung fields seen in 10 patients（90. 9%）,bilateral pleural effusions in 11 patients（100%）and pericardial effusions in 10 patients（90. 9%）. Conclusion Differentiation syndrome is easy to develop into acute respiratory distress syndrome; the mortality rate is very high. Radiologists should analyse chest CT imaging findings,and cooperate closely with the hematologists,identify DS early,rapidly enable rational treatment plan so as to improve the prognosis of the disease and reduce mortality.