急性白血病首次诱导缓解后合并脑梗死报告分析

Report Analysis on Cerebral Infarction after First Induction Remission of Acute Leukemia

目的:探讨急性白血病患者首次诱导缓解后发生脑梗死的特点及可能机制,分析其临床特征,以期为临床医生治疗该疾病提供诊疗参考。方法:基于我院1例急性淋巴细胞白血病患者和1例急性髓系白血病患者化疗后完全缓解期发生脑梗死患者的临床案例,综合分析患者相关指标变化,并结合国内外相近案例回顾分析,探讨急性白血病患者首次诱导缓解后发生脑梗死的特点及可能机制。结果:我院2例急性白血病患者均在缓解期发生脑梗死,较为罕见,血凝学和血小板计数均无异常,但其中急性髓系白血病初诊时白细胞明显升高,且既往合并高血压;急性淋巴细胞白血病患者化疗方案中含有糖皮质激素;另外,2例患者均在骨髓恢复期血小板快速增高。结论:急性白血病后缓解期发生脑梗死较少见,机制尚不明确。既往高血压、糖尿病等病史、发病时高白细胞、化疗药物损伤血管内皮、骨髓恢复期血小板快速升高均为可能原因,临床诊疗时应加强诊疗判断。

Objective:To investigate the characteristics and possible mechanism of cerebral infarction after first induced remission in patients with acute leukemia,and to analyze its clinical features,in order to provide reference for clinical doctors to treat the disease.Methods:Based on the two clinical cases of one acute lymphoblastic leukemia(ALL)patient and the one acute myeloid leukemia(AML)patient who developed cerebral infarction during complete remission after chemotherapy in our hospital,the changes of relevant indicators of the patients were comprehensively analyzed,and the characteristics and possible mechanisms of cerebral infarction in patients with acute leukemia after first induction remission were explored combined with the retrospective analysis of similar cases at home and abroad.Results:Two patients with acute leukemia in our hospital both developed cerebral infarction during remission,which was relatively rare.There were no abnormalities in blood coagulation and platelet count,but the white blood cells of acute myeloid leukemia were significantly increased at the initial diagnosis,and the patient was complicated with hypertension.The chemotherapy regimen for acute lymphoblastic leukemia included glucocorticoids.Platelet count increased rapidly during bone marrow recovery in both of the 2 cases.Conclusion:Cerebral infarction in remission stage after acute leukemia is rare,and the mechanism is still unclear.Previous history of hypertension,diabetes,high white blood cell count at onset,damage of vascular endothelium by chemotherapy drugs,and rapid increase of platelet count during bone marrow recovery are possible causes,which should be recognized in clinical diagnosis and treatment judgment.