80例急性淋巴细胞白血病患儿的诊疗分析

Diagnosis and treatment of 80 cases of children with acute lymphoblastic leukemia

目的探讨急性淋巴细胞白血病(ALL)患儿的临床特征、诊断和治疗方法,以提高临床对小儿ALL的认识。方法依据甲氨蝶呤的治疗剂量将80例急性淋巴细胞白血病患儿分为观察组和对照组,每组40岁,对照组患儿的甲氨蝶呤治疗剂量为3 g/m^(2),观察组患儿的甲氨蝶呤治疗剂量为5 g/m^(2)。比较两组患儿的临床症状、血常规指标、临床疗效和不良反应发生情况。结果两组患儿出血、贫血、肝脾增大、淋巴结肿大、皮下包块、中枢神经系统浸润、睾丸肿大等临床症状比较,差异均无统计学意义(P﹥0.05)。入院时,两组患儿白细胞数计数升高、血小板计数降低、血红蛋白浓度降低率比较,差异均无统计学意义(P﹥0.05)。观察组患儿的临床疗效优于对照组,观察组患儿的治疗总有效率为90.0%,高于对照组患儿的67.5%,差异有统计学意义(P﹤0.05)。两组患儿排泄延迟、胃肠道不适、黏膜损伤、肝功能损害、肾功能损害、骨髓抑制不良反应发生率比较,差异均无统计学意义(P﹥0.05)。结论具有发热、出血、贫血、肝脾增大、淋巴结肿大和皮下包块等临床症状的患儿要警惕ALL的可能,必要时行血常规和骨髓穿刺等检查明确诊断;对于确诊的ALL患儿,采取大剂量甲氨蝶呤治疗安全有效。

Objective To explore the clinical features,diagnosis and treatment methods of children with acute lymphoblastic leukemia(ALL)in order to improve clinical understanding of pediatric ALL.Method According to the treatment dose of methotrexate,80 children with ALL were divided into observation group and control group,each group was 40 cases.The treatment dose of methotrexate for children in the control group was 3 g/m^(2),and the treatment dose of methotrexate for children in the observation group was 5 g/m^(2).The clinical features,results of hematology,clinical efficacy and adverse reactions were compared between the two groups.Result There were no significant differences for occurrence of hemorrhage,anemia,hepatosplenomegaly and lymphonodemegaly,infiltration of central nervous system and enlargement of testes(P>0.05).There were no significant differences for the increases of white blood cell count,decreases of platelet count and hemoglobin concentration during admission(P>0.05).The clinical efficacy of children in the observation group was better than that of the control group(P<0.05).The total effective rate of treatment in the observation group was 90.0%,which was higher than 67.5%in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of delayed excretion,gastrointestinal discomfort,mucosal damage,liver function impairment,renal function impairment,and bone marrow suppression between the two groups(P>0.05).Conclusion Clinically,children with clinical features such as fever,bleeding,anemia,hepatosplenomegaly,lymphonodemegaly and subcutaneous masses should be cautious of the potential of ALL.If necessary,routine blood tests and bone marrow biopsy should be performed to make confirmation.For children with confirmed ALL,the treatment with high-dose methotrexate is safe and effective.