儿童急性淋巴细胞白血病合并癫痫发作的临床研究

发布时间：2018-05-03 10:40

  本文选题：癫痫发作 + 急性淋巴细胞白血病　； 参考：《华中科技大学》2014年博士论文

【摘要】：目的：通过对急性淋巴细胞白血病患儿癫痫发作的时间、病因、发病特点、影响因素及预后的综合分析,为临床中ALL患儿中枢神经系统并发症的及时诊断、病情评估、后续治疗方案的合理选择提供理论依据。 方法：收集武汉协和医院2008-2013年间收治的急性淋巴细胞白血病患儿中发生癫痫发作的病例,并检索和筛选所有已发表且数据完整的类似病例报告,提取患者信息、相关发病情况、治疗经过及随访结果后进行统计分析。 结果：我科2008年-2013年收治的133例急性淋巴细胞白血病患儿中,8人在治疗期间出现癫痫发作。发作相关诊断分别为可逆性后部脑病综合征(4例)、脑血管事件(2例)、未知原因(2例)。纳入20篇文献中74例类似病例后共收集病例82例。其中,可逆性后部脑病综合征30例,甲氨蝶呤相关白质脑病21例,脑血管事件20例,长春新碱相关脑病3例,其他原因及无明确病因8例。1-9岁病例占79.2%(65例)。高危患儿占27%(22例)。诱导缓解期发生的癫痫发作占57%(47例)。1.5%(1例)在发作时存在CNSL证据。15.9%(13例)发作时有既存中枢神经系统器质性损害。18.3%(15例)在初次发作后3个月内再发癫痫发作,11%(9例)随访结束时遗留神经系统异常,4.9%(4例)在初次发作后2月内死亡。 结论： 1.ALL患儿发生癫痫发作与联合化疗密切相关,诱导缓解期发病率最高。 2.主要病因是可逆性后部脑病综合征(PRES)、脑血管事件及MTX相关白质脑病。 3.持续的轻至中度血压升高是PRES发病的危险因素。血浆纤维蛋白原、AT Ⅲ等凝血因子的缺乏以及就诊时高白细胞血症是发生脑血管事件的危险因素。 4. PRES预后与影像学改变密切相关,及时治疗有利于避免不可逆损害的发生。多数病例可继续按原方案化疗,并不遗留神经系统异常。脑血管事件、甲氨蝶呤相关白质脑病患者中存在中枢神经系统器质性改变者预后较差。
[Abstract]:Objective: to analyze the time, etiology, characteristics, influencing factors and prognosis of epilepsy in children with acute lymphoblastic leukemia (ALL) in order to diagnose and evaluate the complications of central nervous system in children with acute lymphoblastic leukemia (ALL). The reasonable choice of follow-up treatment scheme provides theoretical basis. Methods: the epileptic seizures of children with acute lymphoblastic leukemia (ALL) were collected from 2008 to 2013 in Wuhan Union Hospital, and all similar reported cases with complete data were retrieved and screened. The course of treatment and the results of follow-up were analyzed statistically. Results: 8 of 133 children with acute lymphoblastic leukemia (ALL) who were admitted in our department from 2008 to 2013 had epileptic seizures during treatment. Seizure related diagnosis included reversible posterior encephalopathy syndrome in 4 cases, cerebral vascular event in 2 cases and unknown cause in 2 cases. A total of 82 cases were collected after 74 similar cases were included in 20 articles. Among them, 30 cases of reversible posterior encephalopathy syndrome, 21 cases of methotrexate associated leukoencephalopathy, 20 cases of cerebrovascular events, 3 cases of vincristine associated encephalopathy, 8 cases of other causes and 8 cases of undefined etiology. 22 cases of high risk children were diagnosed. (1 case) there is CNSL evidence at the time of seizure. 15.9%) there is organic damage of central nervous system in 15 cases.) within 3 months after the first attack, 9 cases of epileptic seizure occurred 11%) with the presence of CNSL evidence (15 cases); (1 case) 1 case; 1 case; (1 case); 1 case: 1 case of epileptic seizure in the induced remission period; At the end of the visit, 4 patients with neurological abnormalities died within 2 months after the first attack. Conclusion: Epileptic seizures in children with 1.ALL were closely related to combined chemotherapy, and the incidence of induced remission was the highest. 2. The main causes were reversible posterior encephalopathy syndrome, cerebral vascular events and MTX associated leukoencephalopathy. 3. Persistent mild to moderate elevated blood pressure is a risk factor for PRES. The deficiency of plasma fibrinogen AT 鈪，

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