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目的观察中枢神经系统白血病(CNSL)的临床特点及高危因素,采取早期诊断及预防,提高患者长期生存的机会。方法分析36例CNSL患者的临床资料,男15例,女21例;年龄5～57岁,平均年龄26.8岁。其中急性淋巴细胞性白血病21例,急性非淋巴细胞性白血病13例(M12例,M23例,M33例,M42例,M54例),慢粒急变2例。结果 36例CNSL中死亡26例,存活8例,失访2例。死亡原因多为原发病复发所致的相关并发症或中枢神经系统白血病引起的颅内出血、高颅压脑疝形成等。结论 CNSL仍为白血病复发的主要原因,尤以急性淋巴细胞白血病多发,CNSL可发生在急性白血病病程的任何时期,但以缓解期多见,是影响急性白血病患者预后的重要因素。故对于具有发生CNSL危险因素的患者,应引起临床高度重视,重视对CNSL的预防性鞘内注射治疗,以求尽量降低CNSL的发生率,延长患者长期生存时间。
Objective To observe the clinical features and risk factors of central nervous system leukemia (CNSL) and to take early diagnosis and prevention to improve the long-term survival of patients. Methods Clinical data of 36 patients with CNSL were analyzed. There were 15 males and 21 females, aged from 5 to 57 years with a mean age of 26.8 years. There were 21 cases of acute lymphoblastic leukemia, 13 cases of acute non-lymphocytic leukemia (M12 cases, M23 cases, M33 cases, M42 cases, M54 cases) and 2 cases of acute myeloid leukemia. Results Thirty-six CNSL died in 26 cases, survived in 8 cases and lost in 2 cases. Most of the causes of death due to recurrence of the original disease caused by complications or central nervous system leukemia caused by intracranial hemorrhage, intracranial hernia formation and so on. Conclusion CNSL is still the main cause of leukemia recurrence, especially in patients with multiple acute lymphoblastic leukemia, CNSL can occur in any stage of the course of acute leukemia, but more common in remission stage is an important factor affecting the prognosis of patients with acute leukemia. Therefore, patients with risk factors for CNSL should cause clinical attention, pay attention to the preventive intrathecal injection of CNSL in order to minimize the incidence of CNSL and prolong the long-term survival of patients.