肌肉骨关节痛为首发症状的急性白血病临床分析

目的探讨以肌肉骨关节痛为首发症状的急性白血病（AL）临床特征,为早期诊断治疗提供依据。方法对2007～2010年收治的肌肉骨关节痛为首发症状的5例急性白血病临床资料进行回顾性分析,分析其临床特征。结果本组5例均经骨髓细胞学检查确诊为白血病,其中2例为青少年,3例为成人;4例为急性淋巴细胞白血病（ALL）,1例为急性髓细胞白血病（AML）。起病时血常规可以完全正常,也可以有异常。红细胞沉降率和C反应蛋白均明显异常。关节疼痛较剧烈,对非甾体抗炎药反应差,易误诊为类风湿性关节炎,反应性关节炎等。结论对于有不明原因的关节痛或关节炎,且对正规治疗反应差的患者,即使血常规正常,也应考虑到白血病的可能,并应进行相关检查。

Clinical analysis of acute leukemia with muscle,bone and joint pain as first symptoms

Objective To investigate the clinical manifestations and laboratory features of acute leukemia（AL） with muscle,bone and joint pain as initial symptoms and provide theoretical basis for early diagnosis and treatment.Methods Five cases of AL with initial symptoms of muscle,bone and joint pain from 2007 to 2010 in our hospital were retrospectively analyzed.The clinical data and the laboratory test results were collected.Their clinical characteristics and laboratory features were studied and analyzed.Results Of the 5 cases（2 adolescents and 3 adults） 4 were identified as acute lymphoblastic leukemia,and 1 as acute myeloid leukemia.At the onset stage,the blood might be completely normal,though there might be exceptions.Erythrocyte sedimentation rate and C-reactive protein were significantly abnormal.Severe joint pain and poor response to non-steroidal anti-inflammatory drugs were characterized.So the cases were often misdiagnosed as rheumatoid arthritis and reactive arthritis.Conclusion For regular patients with unexplained joint pain or arthritis,as well as poor response to routine treatment,even though their blood test is normal,possibility of leukemia should be taken into account and relevant examinations should be arranged.