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目的探讨儿童急性淋巴细胞白血病(ALL)并发中枢神经系统(CNS)疾病时脑脊液流式细胞学(FCM)检测技术的鉴别诊断价值。方法采用FCM技术、脑脊液常规细胞形态学、脑脊液常规和生化检测对2009年2月至2014年2月在中山大学附属第一医院(包括东院)儿科住院的7例脑脊液淋巴细胞数增多的ALL患儿脑脊液标本进行检测,并对患儿进行治疗追踪,比较FCM与传统方法在诊断ALL并脑病时的差别和准确性。结果按照传统细胞形态学方法,2例诊断为CNS白血病(CNSL),其余诊断不确定;依据FCM检测结果,7例患儿中诊断CNSL 4例,诊断非白血病浸润性疾病3例,通过治疗和追踪,后者确诊病毒性脑膜炎2例,反应性脑膜炎1例。确诊CNSL的4例患儿经过全身和鞘注化疗,1例因疾病进展死亡,其余3例均已获得缓解;2例病毒性脑膜炎患儿经阿昔洛韦治疗病情迅速改善;1例反应性脑膜炎患儿未经治疗,脑脊液逐步恢复正常。结论脑脊液FCM技术敏感度高,可以提供客观、更精确的判断依据,是脑脊液细胞形态学检测方法的重要补充,在儿童ALL并发CNS疾病的鉴别诊断中有重要价值。
Objective To investigate the differential diagnosis of cerebrospinal fluid flow cytometry (FCM) in childhood acute lymphoblastic leukemia (ALL) complicated with central nervous system (CNS) diseases. Methods The FCM technique was used to detect the cerebrospinal fluid (CSF) and the cerebrospinal fluid (CSF) routine and biochemical tests were performed on 7 patients with cerebrospinal fluid lymphocytosis who were hospitalized in the First Affiliated Hospital of Sun Yat-sen University (including the Eastern Hospital) from February 2009 to February 2014 Children with cerebrospinal fluid samples were detected, and the treatment of children with tracing, FCM and traditional methods in the diagnosis of ALL and encephalopathy when the difference and accuracy. Results According to the traditional cell morphology method, 2 cases were diagnosed as CNS leukemia (CNSL), and the rest were undetermined. According to the results of FCM, 7 cases were diagnosed as CNSL in 4 cases and 3 cases were non-leukemia infiltrative disease. Follow-up, which confirmed two cases of viral meningitis, reactive meningitis in 1 case. Four patients diagnosed with CNSL were treated with systemic and intrathecal chemotherapy and one died of disease progression. The remaining three patients were relieved. Two patients with viral meningitis were treated with acyclovir, and their symptoms were rapidly improved. One patient responded Children with meningitis untreated, cerebrospinal fluid gradually returned to normal. Conclusions The high sensitivity of cerebrospinal fluid (FCM) technique can provide an objective and accurate basis for judgment. It is an important complement to cerebrospinal fluid cytomorphometry and is of great value in the differential diagnosis of childhood ALL complicated with CNS diseases.