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目的评价儿童急性淋巴细胞性白血病的早期预后。方法对2000年12月至2006年12月于上海交通大学附属儿童医院确诊的急性淋巴细胞性白血病患儿,给予7d的糖皮质激素治疗。根据第8天外周血幼稚细胞动态变化分为激素反应良好组(PGR)和激素反应不良组(PPR),根据两组临床特点和治疗后转归,明确激素诱导试验在评估早期预后中的价值。结果82例患儿中PGR组65例(79%),PPR组17例(21%)。两组初发白细胞计数、危险分型、D19骨髓相差异有统计学意义(P<0.05)。而形态学、免疫分型、染色体,两组间差异无统计学意义。化疗后转归PGR组59例达CCR,2例放弃,3例复发,1例死亡,复发和死亡占4.61%;而在PPR组中8例CCR,1例缓解后行移植治疗,8例复发,其中1例并发脑白,复发率为47.1%,明显高于PGR组。结论糖皮质激素诱导试验是评估儿童急性淋巴细胞性白血病早期预后的一项重要指标。
Objective To evaluate the early prognosis of children with acute lymphoblastic leukemia. Methods Children with acute lymphoblastic leukemia diagnosed at Shanghai Jiao Tong University Children’s Hospital from December 2000 to December 2006 were treated with glucocorticoid for 7 days. According to the dynamic changes of naive cells in the peripheral blood on the 8th day, they were divided into two groups according to the clinical characteristics and post-treatment outcome: the hormone-responsive group (PGR) and the hormone-refractory group (PPR) . Results Of the 82 children, 65 (79%) had PGR and 17 (21%) had PPR. The initial white blood cell count, risk classification, D19 bone marrow phase difference was statistically significant (P <0.05). Morphology, immunophenotyping, chromosomes, no significant difference between the two groups. In the PGR group, 59 cases achieved CCR after chemotherapy, 2 cases gave up, 3 cases relapsed, 1 case died, and the recurrence and death accounted for 4.61%. In the PPR group, 8 cases were treated with CCR and 1 case received remission and 8 cases were relapsed , Of which 1 case complicated with white, the recurrence rate was 47.1%, significantly higher than the PGR group. Conclusion Glucocorticoid induction test is an important index to evaluate the early prognosis of children with acute lymphoblastic leukemia.