儿童急性淋巴细胞白血病合并巨细胞病毒性视网膜炎6例报道及文献复习

Case Series and Review of the Literature of Six Pediatric Cases with Acute Lymphoblastic Leukemia Combined with Cytomegalovirus Retinitis

目的了解儿童急性淋巴细胞白血病并发巨细胞病毒性视网膜炎(CMVR)的临床特点和治疗转归,分析及总结经验。方法中山大学附属第一医院东院儿科2008年10月至今共收治初治急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患儿262例,对期间合并CMVR的6例患儿进行回顾性分析并跟踪随访。结果 6例ALL并发CMVR患儿给予更昔洛韦或膦甲酸钠抗病毒+地塞米松抗炎治疗。6例中2例双眼有病变的患儿留有后遗症,1例左眼失明,右眼光感;另一例左眼视力为0. 2,右眼失明。另外4例单眼病变患儿2例视力恢复正常,1例单眼视力无好转亦无进展,1例视力损伤加重。结论 ALL患儿化疗后免疫抑制,虽发生率较低,但仍需注意并发CMVR的可能; CD4+细胞<250个/u L及Ig G <500 mg/d L可能为高危因素; CMVR一旦发生如无及时治疗尤其是病变累及视盘者有导致失明的风险,应早发现早治疗方可确保良好的预后。

Objective To investigate the clinical characteristics and the treatment of children with Acute Lymphoblastic Leukemia(ALL)complicated with cytomegalovirus retinitis(CMVR),to analyze and summarize the experience.Methods A total of262patients with newly diagnosed ALL were enrolled in the hospital from October,2008to present,among whom five cases with CMVR were retrospectively analyzed and followed to get the feedback.Result6ALL patients complicated with CMVR were treated with ganciclovir or foscarnet antiviral.Two participants with bilateral lesions had sequelae.One was blind in the left eye,and light perception in the right eye;visual acuity of was the other case0.2in the left eye,and was blind in the right eye.There were4cases of monocular lesions,2participants visual acuity returned to normal,1had no improvement or progress,and1visual injury aggravation.Conclusion Children with ALL under immunosuppression after chemotherapy are likely to suffer concurrent CMVR,although occurring rate is relatively low.CD4+cells<250/uL and IgG<500mg/dL may be high risk factors;Once it occurs,the patient is at the risk of blindness unless timely treatment is performed.Thereby,early detection and early treatment is vitally necessary and essential to ensure a good prognosis.