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目的探讨伴骨质破坏的儿童急性淋巴细胞白血病(ALL)的临床特点及影像学特点。方法回顾分析46例具有骨质破坏的病例,最终依靠骨髓涂片诊断为急性淋巴细胞白血病,其临床特点和X线表现及治疗转归情况。结果伴骨质破坏的儿童ALL患儿临床表现以腰腿痛为首发表现多见占28例(60.87%),骨质破坏的部位以长骨受累最多,占38例(82.61%),X线提示骨质疏松较普遍(56.52%),也有全身多发骨质破坏,个别有腰椎压缩骨折。其中40例患者具有不同程度的贫血和发热,出血表现少见。46例初诊伴有骨质破坏的ALL患儿中,诱导期的总完全缓解率为97.8%,与初诊不伴有骨质破坏的ALL患儿比较缓解率差异无统计学意义。结论提示对临床不能解释的骨质疏松,或以多发骨破坏为主要临床表现的儿童和青少年患者,应考虑到急性白血病可能性,需完善骨髓涂片检查以避免漏诊,并分析X线对此类患者诊断的价值,以提高ALL骨破坏表现的认识。
Objective To investigate the clinical characteristics and imaging features of childhood acute lymphoblastic leukemia (ALL) with bone destruction. Methods Retrospective analysis of 46 cases of bone destruction, the final diagnosis of acute lymphoblastic leukemia by bone marrow smear, its clinical features and X-ray findings and treatment outcome. Results The clinical manifestations of children with ALL accompanied by osteoarthritis were mainly low back and leg pain (28.8%), the long bone involvement was the most in 38 cases (82.61%), the X-ray showed Osteoporosis more common (56.52%), there are multiple systemic bone destruction, individual lumbar compression fractures. Forty of these patients had varying degrees of anemia and fever, with rare bleeding. Among the 46 cases of ALL with newly diagnosed bone destruction, the total complete remission rate during induction was 97.8%. There was no significant difference in remission rate between ALL children with newly diagnosed ALL without bone destruction. The conclusions suggest that for children and adolescents with clinically unexplained osteoporosis or multiple bone destruction as the main clinical manifestations, the possibility of acute leukemia should be considered, bone marrow smears should be improved to avoid missed diagnosis, and X-ray analysis The diagnostic value of the class of patients to improve the understanding of the performance of ALL bone destruction.