急性淋巴细胞白血病合并高嗜酸细胞综合征.DOCVIP

临床医学论文-急性淋巴细胞白血病合并高嗜酸细胞综合征 ???????????? 作者：郝淼旺，梁英民，张静宜，刘利，尹郸丹，刘强，陈任安???? 【摘要】? 　　目的：报告1例急性淋巴细胞白血病合并高嗜酸细胞综合征(ALL/Eo)患者并结合文献进行讨论. 方法：男性患者17岁，因胸闷、低热1 mo入院. 除具有浅表淋巴结和脾脏肿大、胸骨压痛及骨髓原始幼稚淋巴细胞比例增高的ALL临床特点外，还具红斑性皮疹、血栓形成（脾）和心肌内膜纤维化典型HES的临床表现. 结果：入院诊断ALL/Eo，由于经济困难放弃治疗，出院3 mo后死亡. 结论：ALL/Eo是一种罕见病例，一种独特的临床病理学类型，目前全世界报告有50余例. 患者外周血持续性嗜酸细胞增高同时找不到幼稚淋巴细胞且无全血细胞减少，诊断时应全面考虑. 【关键词】? 急性淋巴细胞白血病；高嗜酸细胞综合征；诊断 　　Acute lymphoblastic leukemia complicated with hypereosinophilic syndrome: One case report and a literature review ??? 【Abstract】 AIM: To report a case of acute lymphoblastic leukemia (ALL) complicated with hypereosinophilic syndrome (HES) (ALL/Eo), and review the reported literatures. METHODS: A 17yearold male patient was admitted to the hospital for chest distress and lowgrade fever 1 month. Not only ALL clinical features, such as lymphadenectasis, splenomegaly, chest bone tenderness, higher proportion of immature lymphoblasts of bone marrow cells, but also typical clinical manifestations of HES, such as erythematous skin rash, thrombosis (spleen), endomyocardial fibrosis, were all observed. RESULTS: ALL/Eo was diagnosed for the patient at admission. The patient gave up treatment for the financial strait and died 3 months postdischarge. CONCLUSION: ALL/Eo is a rare disease. More than 50 patients with ALL/Eo have been reported by now in the world. The diagnosis needs comprehensive consideration. ??? 【Keywords】 acute lymphoblastic leukemia; hypereosinophilic syndrome; diagnosis 　　0引言 ??? 嗜酸性粒细胞非克隆性增殖常见于变态反应或超敏反应、寄生虫感染、结缔组织病、免疫缺陷状态、细胞因子治疗和硬化症. 肿瘤相关的嗜酸性粒细胞增高可见于慢性粒细胞白血病［1］，伴嗜酸性粒细胞增高的急性粒细胞单核细胞白血病（FAB: M4EOS），急性淋巴细胞白血病（ALL），霍奇金和非霍奇金淋巴瘤［2］等. 不常见的且不明原因的嗜酸性粒细胞增高称之为高嗜酸细胞综合征（HES），超负荷酸性粒细胞增高可导致体重减轻、疲乏、骨痛、咳嗽和气短，这与其侵犯心脏、肺及皮肤等组织器官有关，最终导致患者多脏器功能衰竭而死亡［3］. ??? ALL是儿童恶性肿瘤最常见的一种类型，年发病率为3/10万［4］，而在成人其相对发病率少于急性非淋巴细胞白血病. 大多数病例表现为正常全血细胞减少，并出现幼稚淋巴细胞；少数病例则不出现正常血细胞减少，也检测不到幼稚淋巴细胞，需要骨髓穿刺涂片才能确诊. 以外周血成熟嗜酸性粒细胞显著增高并引起相应临床并发症（HES）的ALL(早期前B细胞型)（ALL/Eo）是罕见病例，我们于200607收治1例，现报告如下并对该类型ALL的临床特征、病理及可能发病机制的文献进行综述. ??? 1病例