急性淋巴细胞白血病患儿合并深静脉血栓栓塞临床分析

Clinical Analysis of Deep Venous Thromboembolism in Children with Acute Lymphocytic Leukemia

目的:探讨急性淋巴细胞白血病(ALL)儿童发生深静脉血栓的临床特点及转归。方法:对2010.1.1-2016.5.31确诊的266例ALL患儿中发生血栓的12例(占4.5%)进行了回顾性分析。对2015.1.1前诊断的183例患儿采用SCMC-ALL-05-方案治疗,对2015.1.1后诊治的80例患儿采用CCCG方案治疗。考虑有血栓形成者行彩超、MRI检查明确诊断。结果:发生深静脉血栓(DVT)的12例患儿中10例为肢体深静脉血栓,2例为颅内静脉窦血栓。DVT多发生在诱导或再诱导期间,中危患儿多发,大部分有感染及凝血象异常。给患儿以低分子肝素(LWHP)治疗,其中拔管5例;6例1周左右彩超复查显示血栓消失;1例颅内静脉窦血栓患儿半年后复查头颅MRI显示改善不明显。发生过DVT患儿,应用培门冬酰胺酶时给予LWHP预防治疗,其结果未再有血栓发生。结论:深静脉置管和化疗药物是发生血栓的主要因素;凝血功能异常、感染、危险度分层是血栓形成的危险因素。发生过血栓的患儿再次应用培门冬酰胺酶时予LWHP预防在临床上是获益的。

Objective： To explore clinical characteristics and outcome of deep vein thrombosis（ DVT） in children with acute lymphoblastic leukemia（ ALL）. Methods： A tatol of 266 patients were diagnosed as ALL from January 1,2010 to May 31,2016. The clinical data of 12 cases of patients with DVT were retrospectively analyzed,183 cases diagnosed before January 1,2015 were received chemotherapy with the scheme of SCMC-05. The other cases were treated by the scheme of CCCG. All the patients received central venous catheter. Results： The DVT happened in 12 cases including 10 cases of limb DVT and 2 cases of intacranial venous sinus thrombosis. The DVT mostly occured in intermediate risk ALL patients,the infection and coagulopathy existed in most patients. They were treated with low molecular heparin（ LWHP）,among them 5 cases were given extubation; the thrombus disappeared in 6 cases after 1 week; the intracranial venous sinus thrombosis in 1 case did not obviously improved after 6 months of treatment. The ALL children with DVT were treated with LWHP when using L-ASP,as a result no thrombuses happened. Conclusion： Centralvenous catheter and chemotherapeutic drugs were the major cause of DVT. Abnormal coagulation,infection,and risk stratification are another risk factors for thrombosis. ALL children thrombosis are benefited from LWHP prevention when using L-ASP again.