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目的:提高对以电解质紊乱为首发症状的儿童急性淋巴细胞性白血病的认识。方法:回顾性分析1例以高钙血症及低钾血症为首发表现的儿童急性淋巴细胞性白血病,复习相关文献,认识此类疾病的临床表现、发病机理、治疗及转归。结果:患儿以恶心、呕吐、乏力、嗜睡为突出表现,临床检验提示明显的高钙血症及低钾血症,血钙最高时4.87 mmol·L~(-1),血钾最低时2.6 mmol·L~(-1)。患儿逐步出现三系减少,两次骨穿均示原幼淋比例增高,第1次原淋+幼淋占16%,1个月后原淋+幼淋占30.0%,急性淋巴细胞性白血病诊断明确。结论:高钙血症是恶性肿瘤常见的并发症,但儿童急性淋巴细胞性白血病以高钙血症为首发表现的非常少见,甲状旁腺激素相关肽等体液因子的分泌可能是其高钙血症的主要原因。合并有高钙血症的急性淋巴细胞性白血病患儿的预后因目前观察的病例太少无法判断,有待更多的病例研究。
OBJECTIVE: To raise awareness of acute lymphoblastic leukemia in children with electrolyte imbalance as the first symptom. Methods: One case of childhood acute lymphoblastic leukemia with hypercalcemia and hypokalemia as the first manifestation was retrospectively reviewed. The related literatures were reviewed and the clinical manifestations, pathogenesis, treatment and prognosis of such diseases were reviewed. Results: Nausea, vomiting, fatigue and drowsiness were the most prominent manifestations in children. Clinical examination revealed obvious hypercalcemia and hypokalemia with the highest serum calcium of 4.87 mmol·L -1 and the lowest serum potassium of 2.6 mmol·L -1. Children gradually showed three lines to reduce the two bone wear are shown in the proportion of the original baby shower increased, the first primary leaching accounted for 16% of leaching, 1 month after the original leaching + 30.0% of leaching, acute lymphoblastic leukemia Diagnosis is clear. Conclusion: Hypercalcemia is a common complication of malignant tumors. However, the first manifestation of hypercalcemia in children with acute lymphoblastic leukemia is very rare. The secretion of humoral factors such as parathyroid hormone-related peptide may be the result of hypercalcemia The main reason for the disease. The prognosis of children with acute lymphoblastic leukemia complicated with hypercalcemia is too small to judge because of the current observation, and more case studies are needed.