14例小儿骨髓坏死临床特点及实验室诊断分析

目的分析近八年郑州大学第一附属医院儿科骨髓坏死(BMN)病例,了解BMN在儿科的发病特点。方法对1996年1月至2003年9月14例小儿BMN的临床表现,实验室检查及原发病诊断进行比较,并做回顾性分析总结。结果12例(86%)并发于恶性疾病,其中6例原发病为急性淋巴细胞性白血病(ALL),神经母细胞瘤(NB)和急性髓细胞性白血病(AML)各2例,非何杰金淋巴瘤(NHL)和MDS各1例;2例(14%)并发于非恶性疾病,其中一例为结核感染,另一例为金黄色葡萄球菌败血症。最显著的临床表现依次为:骨痛12例,发热11例,苍白10例,黄疸7例,皮肤粘膜出血6例。最常见的实验室发现依次为贫血10例,血小板减少7例;骨髓细胞学分析发现轻度骨髓坏死2例,中度4例,重度8例。结论恶性血液肿瘤和恶性转移瘤是小儿BMN的最常见病因,另外严重感染也是小儿BMN的常见病因之一。

Diverse etiology of bone marrow necrosis and clinical, laboratory analysis of 14 cases in children

Objective Bone marrow necrosis (BMN) is a relatively uncommon clinical entity ,especially in childhood .The etiology is diverse ,and malignancy is the most common underlying disease of BMN. To investigate the clinical ,laboratory and diagnostic characteristics of BMN in children, 14 cases with BMN were involved in this study. Methods 14 children with BMN, which were detected during the last 8 years in department of pediatrics, the first affiliated hospital of ZhengZhou university, were studied retrospectively. Results Twelve of these 14 cases (86%) had underlying malignant disease, and two (14%) had nonmalignant disease. Among the malignant cases, six cases had acute lymphoblastic leukemia (ALL), two hadneuroblastoma(NB), two had acute myeloblastic leukemia (AML), one had non-Hodgkin's lymphoma (NHL), and one had myelodysplastic syndrome (MDS). Among two nonmalignant cases, one had tuberculosis infection, the other one had staphyinococcemia. The most common symptoms were bone pain, fever, pallor and jaundice. The most common laboratory findings were anemia, leukopenia, thrombocytopenia. BMN was graded according to the extent of necrosis in the BM aspirate smear, and necrosis was extensive in 8 cases; moderate in 4 cases; and mild in 2 cases. Conclusion Both malignant hematopoietic original tumor and malignant metastatic tumor are the most common causes of BMN in children and some serious infections are the common causes of BMN in children as well.