Page 94 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第41卷第4期
·564 · Journal of Nanjing Medical University（Natural Sciences） 2021年4月

·临床医学·

儿童急性淋巴细胞白血病中枢复发的临床分析

杨 凯 ，方拥军 ，孙晓燕 ，戎留成 ，张 永 2
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南京医科大学附属儿童医院血液肿瘤科，药学部，江苏 南京 210008
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［摘 要］ 目的：探讨儿童急性淋巴细胞白血病（acute lymphonblastic leukemia，ALL）中枢神经系统复发的危险因素。方法：回
顾性分析2013年1月—2018年7月南京医科大学附属儿童医院治疗的426例ALL患儿临床资料。将研究对象按照不同的治
疗方案和临床特征分组，比较中枢复发率，并分析中枢复发的危险因素及复发患儿的预后不良因素。结果：①CCCG⁃ALL⁃2015
方案治疗的患儿中枢复发率低于儿童急性淋巴细胞白血病诊疗建议（2006方案）治疗的患儿（P < 0.01）；②男性、白细胞计数≥
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50×10 个/L、T 细胞急性淋巴细胞白血病（T⁃cell acute lymphoblastic leukemia，T⁃ALL）患儿中枢复发率明显较高（P < 0.05）；③
Logistic多因素回归分析提示白细胞计数≥50×10 个/L和T⁃ALL是中枢复发的独立危险因素（P < 0.05）；④Kaplan⁃Meier生存分
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析发现激素诱导后外周血幼稚细胞计数≥1×10 个/L、血小板计数≤20×10 个/L 的中枢复发患儿总生存率更低（P < 0.05）。结
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论：2015方案较2006方案有效减少了中枢复发；2015方案与2006方案的危险因素相同，存在中枢复发高危因素的病例应加强
中枢复发的预防。
［关键词］ 急性淋巴细胞白血病；中枢神经系统；复发；危险因素
［中图分类号］ R725.5 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）04⁃564⁃05
doi：10.7655/NYDXBNS20210415

Clinical analysis of children with CNS relapsed acute lymphoblastic leukemia

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YANG Kai ，FANG Yongjun ，SUN Xiaoyan ，RONG Liucheng ，ZHANG Yong 2
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Department of Hematology and Medical Oncology，Department of Pharmacy，the Affiliated Children’s Hospital of
Nanjing Medical University，Nanjing 210008，China
［Abstract］ Objective：To explore the risk factors of the central nervous system recurrence in children with acute lymphoblastic
leukemia. Methods：Retrospectively analyzed clinical data of 426 children with ALL treated in our hospital from January 2013 to July
2018. The subjects were divided into two groups according to different treatment plan and clinical characteristics to compare the
recurrence rate of the central nervous system，and to analyze the risk factors of central recurrence and the poor prognostic factors of
children with recurrence. Results：①The central recurrence rate of Children treated with CCCG⁃ALL⁃2015 scheme（scheme 2015）was
lower than that of children treated with diagnosis and treatment of childhood acute lymphoblastic leukemia（scheme 2006）（P < 0.01）；
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②The central recurrence rate of children with male，leukocyte count≥50×10 /L and T⁃ALL was significantly higher（P < 0.05）；③
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Logistic regression analysis suggested that leukocyte count≥50×10 /L and T⁃ALL were independent risk factors of central recurrence
（P < 0.05）；④K⁃M survival analysis showed that the overall survival rate of children with hormone induced peripheral blood immature
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cell count≥1 × 10 /L and platelet count≤20 × 10 /L was lower（P < 0.05）. Conclusion：Scheme 2015 effectively reduced central
recurrence compared with scheme 2006. The risk factors of the 2015 regimen were the same as those of the 2006 regimen，and the
prevention of central recurrence should be strengthened in the cases with central recurrence risk factors.
［Key words］ acute lymphoblastic leukemia；central nervous system；relapse；risk factor
［J Nanjing Med Univ，2021，41（04）：564⁃568］

［基金项目］ 国家自然科学基金（81670155，81602913）；江苏 急性淋巴细胞白血病（acute lymphonblastic leu⁃
省妇幼重点学科（FXK201742） kemia，ALL）是儿童时期最易发生的血液系统恶性
∗ 肿瘤，它是由骨髓 T 系或 B 系淋巴细胞异常增殖导
通信作者（Corresponding author），E⁃mail：fyj322@189.cn