以肾脏疾病为首发表现的儿童急性淋巴细胞白血病临床特征分析

Clinical characteristics of child acute lymphoblastic leukemia with renal disease as the first manifestation

目的探讨以儿童肾脏损害为首发表现的急性淋巴细胞白血病的临床特征以及治疗情况。方法回顾性分析2010年1月至2020年3月在湖南省儿童医院住院治疗的以肾脏损害为首发表现、最终确诊为急性淋巴细胞白血病的9例患儿的临床特征以及治疗方法。结果9例患儿中,年龄最小为6个月,最大为11岁2个月,中位年龄5岁11个月;男性患儿6例(66.7%),女性患儿3例(33.3%);病程最短1天,最长1个月,中位病程10天。临床表现:发热4例(44.4%)、水肿3例(33.3%)、瘀斑或瘀点3例(33.3%)、血尿2例(22.2%)、泡沫尿2例(22.2%)、尿少2例(22.2%)、眼睛突出1例(11.1%)、听力下降1例(11.1%)、淋巴结肿大3例(33.3%)、肾脏肿大4例(44.4%)。检验及检查结果:除1例未行泌尿系B超,其余8例均接受泌尿系B超检查,均有实质回声增强,7例(87.5%)可见肾脏肿大;白细胞升高4例(44.4%)、白细胞减少2例(22.2%)、血小板减少4例(44.4%)、贫血6例(66.7%)、乳酸脱氢酶升高8例(88.9%)、血肌酐升高5例(55.6%)、血钙升高2例(22.2%)、血钙降低2例(22.2%)、蛋白尿5例(55.6%)、血尿3例(33.3%)。2例放弃治疗,1例选择干细胞移植,6例使用VDLD化疗方案进行诱导缓解治疗。结论急性淋巴细胞白血病可累及肾脏,肾脏疾病患儿若出现白细胞明显升高、与临床不相符的肾脏肿大、未发生溶血的情况下伴有乳酸脱氢酶升高或明显的高钙血症,临床需考虑存在急性淋巴细胞白血病可能,尽早完善骨髓穿刺。

Objective To investigate the clinical characteristics and treatment of child acute lymphoblastic leukemia(AML)with renal damage as the first manifestation.Methods The clinical characteristics and therapies were retrospectively analyzed of nine cases of AML with renal damage as the first manifestation in Hunan Children's Hospital between January 2010 and March 2020.Results Among the nine cases,the youngest was only six months old,and the oldest was 11 years and two months old,with the median age 5 years and 11 months.Six cases(66.7%)were male children and three cases(33.3%)were female children.The shortest course of disease was one day,and the longest was one month,with the median course of disease 10 days.Of the nine cases,there were four cases(44.4%)having fever,three cases(33.3%)with edema,four cases(44.4%)with ecchymosis or stasis,two cases(22.2%)with hematuria,two cases(22.2%)with foam urine,two cases(22.2%)with oliguria,one case(11.1%)with prominent eyes,and one case(11.1%)with hearing loss.Except for one case did not have B-mode ultrasound examination,eight cases had enhanced echo in urinary system,and seven cases(87.5%)had renal hypertrophy.In addition,there were four cases(44.4%)with leukocytosis,two(22.2%)with leukopenia,four(44.4%)with thrombocytopenia,six(66.7%)with anemia.Eight cases(88.9%)had increased lactate dehydrogenase,five(55.6%)had increased serum creatinine,two(22.2%)had increased blood calcium,two(22.2%)had blood calcium,five(55.6%)had proteinuria,three(33.3%)had hematuria.Two cases gave up treatment,one case chose stem cell transplantation,and six cases got VDLD therapy for induced remission.Conclusion Acute lymphoblastic leukemia can involve the kidney.When children with renal disease had leukocytosis,renal hypertrophy inconsistent with clinical practice,increase of blood lactate dehydrogenase or hypercalcemia without hemolysis,the possibility of acute lymphoblastic leukemia should be considered in clinical practice,and bone marrow aspiration should be done as soon as possible.