本文選題：癲癇發(fā)作 + 急性淋巴細胞白血病��； 參考：《華中科技大學》2014年博士論文

【摘要】：目的：通過對急性淋巴細胞白血病患兒癲癇發(fā)作的時間、病因、發(fā)病特點、影響因素及預后的綜合分析,為臨床中ALL患兒中樞神經(jīng)系統(tǒng)并發(fā)癥的及時診斷、病情評估、后續(xù)治療方案的合理選擇提供理論依據(jù)。 方法：收集武漢協(xié)和醫(yī)院2008-2013年間收治的急性淋巴細胞白血病患兒中發(fā)生癲癇發(fā)作的病例,并檢索和篩選所有已發(fā)表且數(shù)據(jù)完整的類似病例報告,提取患者信息、相關(guān)發(fā)病情況、治療經(jīng)過及隨訪結(jié)果后進行統(tǒng)計分析。 結(jié)果：我科2008年-2013年收治的133例急性淋巴細胞白血病患兒中,8人在治療期間出現(xiàn)癲癇發(fā)作。發(fā)作相關(guān)診斷分別為可逆性后部腦病綜合征(4例)、腦血管事件(2例)、未知原因(2例)。納入20篇文獻中74例類似病例后共收集病例82例。其中,可逆性后部腦病綜合征30例,甲氨蝶呤相關(guān)白質(zhì)腦病21例,腦血管事件20例,長春新堿相關(guān)腦病3例,其他原因及無明確病因8例。1-9歲病例占79.2%(65例)。高�；純赫�27%(22例)。誘導緩解期發(fā)生的癲癇發(fā)作占57%(47例)。1.5%(1例)在發(fā)作時存在CNSL證據(jù)。15.9%(13例)發(fā)作時有既存中樞神經(jīng)系統(tǒng)器質(zhì)性損害。18.3%(15例)在初次發(fā)作后3個月內(nèi)再發(fā)癲癇發(fā)作,11%(9例)隨訪結(jié)束時遺留神經(jīng)系統(tǒng)異常,4.9%(4例)在初次發(fā)作后2月內(nèi)死亡。 結(jié)論： 1.ALL患兒發(fā)生癲癇發(fā)作與聯(lián)合化療密切相關(guān),誘導緩解期發(fā)病率最高。 2.主要病因是可逆性后部腦病綜合征(PRES)、腦血管事件及MTX相關(guān)白質(zhì)腦病。 3.持續(xù)的輕至中度血壓升高是PRES發(fā)病的危險因素。血漿纖維蛋白原、AT Ⅲ等凝血因子的缺乏以及就診時高白細胞血癥是發(fā)生腦血管事件的危險因素。 4. PRES預后與影像學改變密切相關(guān),及時治療有利于避免不可逆損害的發(fā)生。多數(shù)病例可繼續(xù)按原方案化療,并不遺留神經(jīng)系統(tǒng)異常。腦血管事件、甲氨蝶呤相關(guān)白質(zhì)腦病患者中存在中樞神經(jīng)系統(tǒng)器質(zhì)性改變者預后較差。
[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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