以肾病综合征为初始表现的慢性淋巴细胞白血病1例并文献复习

Chronic lymphocytic leukemia with nephrotic syndrome as the initial manifestation:report of 1 case and review of literature

目的探讨慢性淋巴细胞白血病患者肾脏受累的临床表现、诊断和治疗。方法回顾性分析2020年10月福建省人民医院收治的1例以肾病综合征为初始表现的慢性淋巴细胞白血病患者的临床资料,并复习相关文献。结果患者为68岁男性,以反复全身水肿、泡沫尿为初始表现,就诊肾内科诊断为肾病综合征,治疗后未见明显改善并逐渐出现淋巴细胞增高,就诊血液科确诊为慢性淋巴细胞白血病。应用伊布替尼单药治疗后淋巴细胞计数和尿蛋白逐渐降至正常,随访结束患者临床疗效评价为完全缓解。结论以肾病综合征为初始表现的慢性淋巴细胞白血病较为罕见,临床异质性较大,尽早诊断是治疗成功的保障,一线Bruton酪氨酸激酶抑制剂单药治疗的效果和安全性较好。

Objective To investigate the clinical manifestation,diagnosis and treatment of chronic lymphocytic leukemia patients with renal involvement.Methods The clinical data of a chronic lymphocytic leukemia patient with nephrotic syndrome as the initial manifestation in Fujian Provincial People's Hospital in October 2020 were retrospectively analyzed,and the related literature was reviewed.Results The patient was a 68-year-old male with recurrent edema and foam urine as the initial manifestations,and he was diagnosed as nephrotic syndrome in the nephrology department.After treatment,the symptoms showed no significant improvement,and the lymphocyte count gradually increased.The patient was diagnosed as chronic lymphocytic leukemia in the hematology department.After ibrutinib monotherapy,the lymphocyte count and urine protein gradually decreased to normal levels,and the clinical efficacy evaluation of the patient was complete remission at the end of follow-up.Conclusions Chronic lymphocytic leukemia with nephrotic syndrome as the initial manifestation is rare,and the clinical presentations are variable.Early diagnosis is the guarantee of successful treatment.The efficacy and safety of first-line Bruton tyrosine kinase inhibitor monotherapy are good.