脑脊液细胞学检查在诊断小儿中枢神经系统白血病中的应用

目的探讨脑脊液细胞学检查在诊断中枢神经系统白血病中的价值。方法采用粟氏FMU-5微型细胞玻片离心沉淀仪收集脑脊液中细胞,显微镜下观察。结果18例各型白血病患儿126例次脑脊液细胞学检查,病例及标本阳性率分别为38.8％和15.9％。结论脑脊液细胞学检查是诊断中枢神经系统白血病的可靠方法,尤其是在临床表现阴性的患儿更为重要。此法对小儿中枢神经系统白血病的早期诊断、预后判断、治疗监护均有十分重要的价值。     

小儿急性白血病的脑脊液细胞学检查

本文对38例各型急性白血病患儿进行168次脑脊液细胞学检查,病例和标本阳性率分别为50%和40.2%。认为脑脊液细胞学检查对于小儿中枢神经系统白血病的诊断是敏感可靠的客观指标,优于脑脊液蛋白量和细胞总数检查。脑脊波中白血病细胞可以在治疗的各期发现,以缓解期多见,该项检查对于小儿中枢神经系统白血病的早期诊断、预后判断、治疗监护方面有实用价值。     

脑脊液细胞因子检测在小儿中枢神经系统感染鉴别诊断中的意义

目的　探讨脑脊液 (CSF)γ 干扰素 (IFN γ)、粒细胞集落刺激因子 (G CSF)、α肿瘤坏死因子 (TNF α)、白细胞介素 6 (IL 6 )及白细胞介素 8(IL 8)的变化在小儿中枢神经系统感染 (CNSI)中的诊断价值。方法　采用双抗体夹心ELISA法检测 14例化脓性脑膜炎 (PM)、30例病毒性脑膜炎 (VM)及2 2例非中枢神经系统感染患儿CSF中IFN γ、G CSF、TNF α、IL 6及IL 8水平。结果　PM组G CSF及IL 8[(132± 4 1)、(2 5 3± 0 5 6 ) μg/L]水平明显高于VM组 [(5 3± 2 2 )、(0 5 3± 0 4 6 ) μg/L](P <0 0 0 1) ;IFN γ在VM组 [(2 0± 0 4 ) μg/L]水平明显高于PM组 [(0 8± 0 5 ) μg/L](P <0 0 1) ;各脑膜炎组中TNF α及IL 6水平均高于对照组 (P <0 0 0 1) ,但各组间比较差异无显著性。G CSF及IL 8水平增高程度与CSF中性粒细胞计数呈正相关 ;IFN γ增高程度与CSF白细胞数及葡萄糖定量间无相关性。结论G CSF、INF γ及IL 8在CSF中显著增高有助于PM与非PM的鉴别诊断 ;TNF α、IL 6在感染性脑膜炎发病过程中的作用是非特异性的 ,其在CSF中的变化对感染性脑膜炎患儿鉴别诊断无临床意义     

脑脊液肿瘤坏死因子测定在中枢神经系统白血病的临床意义

本文检测１００例正常人，急性白血病患儿脑脊液中肿瘤坏死因子（ＴＮＦ），并对已发生中枢神经系统白血病（ＣＮＳＬ）的１０例患儿进行动态监测，测得正常儿童脑脊液（ＣＳＦ）中ＴＮＦ为８．８６±０．８０ｎｇ／ｍｌ，无发生ＣＮＳＬ儿童ＣＳＦ中ＴＮＴ为９．３２±１．５２ｎｇ／ｍｌ，而发生ＣＮＳＬ儿童ＣＳＦ中ＴＮＴ显著升高达２０．６１±２．２１ｎｇ／ｍｌ，治疗缓解后下降为９．１６±０．７６ｎｇ／ｍｌ。提示ＴＮＦ检     

小儿急性白血病脑脊液细胞离心检查

用细胞玻片离心法对７８例急性白血病患儿４１８次脑脊液标本进行了细胞学检查，阳性率分别为６０．３％和３７．８％。这是一种简单、快速、有效的方法，对儿童中枢神经系统白血病检查比传统的测压、白细胞计数、蛋白定量三项指标敏感、可靠，可用于中枢神经系统白血病的早期诊断、疗效观察。     

中枢神经系统疾病患儿脑脊液兴奋性氨基酸的变化

用丹酰化反应聚酰胺薄层层析及荧光法测定１９例化脓性脑膜炎、６例病毒性脑炎、８例癫痛持续状态（ＳＥ）和２１例热性惊厥患儿脑脊液中２２种氨基酸成分。结果表明，与对照组相比，化脓性脑膜炎时１８种氨基酸显著升高，其中谷氢酸、天冬氢酸、丝氨酸及甘氨酸为兴奋性氢基酸。ＳＥ时谷氢酸、天冬氨酸、丝氨酸、赖氨酸及谷氨酞胺显著升高。病毒性脑炎时除谷氨酸不高外，余同ＳＥ。热性惊厥时只有天冬氨酸显著升高。抑制性氨基酸γ－氨基丁酸在各病组均无明显改变。提示在四种常见神经系统疾病时脑内存在兴奋毒性。     

脑脊液肿瘤坏死因子测定在中枢神经系统白血病的临床意义

本文检测１００例正常人，急性白血病患儿脑脊液中肿瘤坏死因子（ＴＮＦ），并对已发生中枢神经系统白血病（ＣＮＳＬ）的１０例患儿进行动态监测，测得正常儿童脑脊液（ＣＳＦ）中ＴＮＦ为８．８６±０．８０ｎｇ／ｍｌ，无发生ＣＮＳＬ儿童ＣＳＦ中ＴＮＴ为９．３２±１．５２ｎｇ／ｍｌ，而发生ＣＮＳＬ儿童ＣＳＦ中ＴＮＴ显著升高达２０．６１±２．２１ｎｇ／ｍｌ，治疗缓解后下降为９．１６±０．７６ｎｇ／ｍｌ。提示ＴＮＦ检测对临床观察ＣＮＳＬ的发生发展与转归有一定价值。     

儿童中枢神经系统白血病22例临床分析

目的分析22例急性白血病合并中枢神经系统白血病(CNSL)患儿的住院资料,为CNSL诊治提供参考。方法分析22例儿童CNSL的临床特征、实验室检查及预后。结果在303例儿童急性白血病中发生CNSL 22例,发生率7.3%,其中急性淋巴细胞白血病(ALL)18例,急性混合型白血病(MPAL)1例,急性髓细胞白血病(AML)3例;在18例ALL中,B-ALL 11例,T-ALL 7例,T-ALL合并CNSL发生率(22.6%)高于B-ALL(5.6%);CNSL常见临床表现有头痛、呕吐、惊厥及瘫痪等;CNSL预后差,死亡率高。结论 CNSL是急性白血病复发的主要原因之一,根据危险度来预防和治疗CNSL是关键。     

应用巢式聚合酶链反应诊断中枢神经系统白血病初探

应用巢式聚合酶链反应技术，扩增急性淋巴细胞白血病患儿脑脊液细胞中Ｔ细胞受体基因Ｖδ＿２Ｄδ＿３重排片段，作为白血病细胞克隆特异性标志，检测脑脊液中微量白血病细胞。结果：２０例患儿（３６份）脑脊液中有１２例（１５份）脑脊液标本阳性，阴性对照脑脊液未见特异扩增带。提示该法诊断中枢神经系统白血病，可能是一种敏感的方法。     

Elevation of Cerebrospinal Fluid Sialic Acid Concentration in Children with Central Nervous System Leukemia

ABSTRACT. We studied sialic acid in the cerebrospinal fluid (CSF) of 52 children with leukemia and 51 children with non-leukemic diseases. The CSF sialic acid concentration in the children with central nervous system (CNS) leukemia was significantly higher than that in the children with acute lymphoblastic leukemia without CNS involvement, acute non-lymphocytic leukemia without CNS involvement, non-hemopoietic diseases, non-suppurative meningitis, epilepsy, and other neurologic diseases. Serial determinations revealed a rapid decline in the CSF sialic acid concentrations in the patients with CNS leukemia who responded well to the therapy and who were free from relapse of CNS leukemia. The simultaneously determined CSF β2 microglobulin concentration did not show any significant changes. These results suggest that the CSF sialic acid may be a good indicator of CNS leukemia.     

Central Nervous System Relapse Surveillance by Serial Beta2-Microglobulin Measurements in Childhood Acute Lymphoblastic Leukemia

ABSTRACT. Beta₂-microglobulin (β₂m) is synthesized particularly in lymphocytes. Its value for early detection of central nervous system (CNS) involvement in acute lymphoblastic leukemia in children was tested by serial determinations. Before 9 overt CNS relapses, the mean increase of the cerebrospinal fluid (CSF) β₂m concentration was 588 μg/l/month (range: -50 to +2020), which was significantly higher than the steady levels during maintenance treatment. Although the absolute value of CSF β₂m was increased to 1430 μg/l in the group with overt CNS relapse, individual variations in CSF β₂m before a relapse were so great that no difference was seen between samples from CSF with or without lymphoblasts. The ratio between β₂m in the CSF and in serum did not increase in serial samples prior to overt relapse, but the ratio was higher in patients with CNS relapse compared with a control group on maintenance therapy. In 9 children without CNS leukemia, the β₂m concentration in CSF and serum decreased to a nadir 4 weeks after the start of induction treatment. The subsequent increase of CSF β₂m was similar to the increase before a CNS relapse. Mean values of CSF β₂m changes differed between groups of children with and without CNS leukemia early in the induction phase and during the maintenance treatment, but the wide range in individual values made serial β₂m determinations unsuitable for detecting a CNS relapse.     

The Prognosis and Survival of Childhood Acute Lymphoblastic Leukemia with Central Nervous System Relapse

Central nervous system (CNS) relapse in childhood acute lymphoblastic leukemia (ALL) has been overcome by sensitive therapatic approachs. This study was planned to present the development of CNS relapse and survival in newly diagnosed 190 ALL patients whose cases were followed in the authors' unit between March 1991 and May 2002. St. Jude Study XI protocol was given to the patients who applied between March 1991 and March 1997 (group A) (n = 122), and St. Jude Study XIII protocol was given to the patients who applied between March 1997 and May 2002 (group B) (n = 68). The patients having isolated CNS relapse in group A received craniospinal irradiation (CSI) median 3.5 months after CNS relapse (range 2–6 months), a short time after reinduction, and 2 cures of consolidation. In group B, patients having isolated CNS relapse received IT once a month and a high-dose methotrexate treatment once every 8 weeks and 3 or 4, cures later therapy CSI median 7 months after CNS relapse (range 6–8 months) was given. When the overall survival rates of the 2 groups are compared, a statistically significant higher survival rate at 5 years was determined in group B than in group A (respectively, 82.3%, 58.4%) (p < .05). When subgroups of the patients (that is, those with no relapse, isolated CNS or BM relapse, or CNS + BM relapse) were compared in both groups, it was found that survival was much higher for the ones with no relapse and with isolated CNS relapse (respectively, 87.9%, 72.7%) compared to isolated BM or CNS + BM relapse groups (respectively, 10%, 13.3%) (p < .05). In a conclusion, for children with acute lymphoblastic leukemia and an isolated CNS relapse, with delayed definitive craniospinal irradiation allowing more intensive systemic and intrathecal chemotherapy results in better overall survival than has been previously reported.     

Central Nervous System Leukemia and Cushing Syndrome

We treated a child with acute lymphoblastic leukemia who developed central nervous system leukemia and obesity due to Cushing syndrome. The infiltration of leukemic cells was gradually ameliorated with intrathecal nethotrexate therapy. At the same time, clinical symptoms of Cushing syndrome have almost normalized. The relation between central nervous system leukemia and Cushing syndrome is discussed.     

中枢神经系统暗色丝孢霉病1例及文献复习

目的探讨中枢神经系统暗色丝孢霉病的临床特征、诊断、治疗及预后。方法对收住1例患儿的临床表现、实验室检查、头颅影像学检查、脑活检组织病理及培养结果进行分析,随访观察其疗效。结果患儿为3岁6个月男童,因间断头痛伴呕吐3个月、双下肢乏力伴尿潴留9 d入院。头颅CT与MRI平扫示颅内多发钙化灶伴周围明显水肿,胸腰椎MRI提示T7椎体水平脊髓局灶信号异常,增强MRI扫描示病灶周边强化。颅内病变处活检提示变性坏死肉芽肿性炎症,其中见暗色粗大的真菌菌丝和芽孢。活检组织与脑脊液培养出同一病原,经鉴定为皮炎外瓶霉。应用两性霉素B与伊曲康唑2个月,疗效不佳,患者自动出院,1个月后死亡。结论皮炎外瓶霉引起的中枢神经系统暗色丝孢霉病非常少见,是最严重的真菌感染类型;组织病理检查与培养是确诊的依据,该病治疗困难,预后不佳。     

Central Nervous System Involvement in Congenital Visceral Fibromatosis

Congenital visceral myofibromatosis is an uncommon disorder characterized by multiple tumors of myofibroblastic origin in the neonatal period. The natural history of the disorder has been well delineated. The myofibro blast is the cell of origin of the tumor. This is a report of a patient in whom multiple mesenchymal tumors occurred in the CNS as well as in other organs. Light and electron microiscopic findings of the CNS lesions are similar to those of the somites and viscera.     

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??Childhood acute lymphoblastic leukemia is the first disseminated cancer shown to be curable. Central nervous system leukemia ??CNSL?? is one of reasons that cause leukemia replase and is associated with a poor prognosis. Pediatricians should master the diagnostic techniques??modalities of prophylaxis and therapy of CNSL in patients with childhood acute lymphoblastic leukemia.     

急性淋巴细胞性白血病患儿脑脊液铁蛋白

研究目的发探讨白血病患儿脑脊液铁蛋白（CSF－Ft）含量的变化及其临床意义。研究方法经骨髓检查确诊的急性淋巴细胞性白血病患儿42例，分为3组，Ⅰ组（诱导治疗期不伴中枢神经系统白血病）14例，Ⅱ组（完全缓解期不伴中枢神经系统白血病）24例，Ⅲ组（合并中枢神经系统白血病）18例。病毒性脑炎（病脑）组17例，对照组15例均无中枢神经系统疾病。用放射免疫分析法检测CSF－Ft及血清铁蛋白。结果Ⅰ、Ⅱ、Ⅲ组、病脑组和对照组患者CSF－Ft含量分别为7．03±2．21μg／L，6．75±1．94μg／L，31．06±8．85μg／L，7．26±1．83μg／L和6．52±1．57μg／L。Ⅲ组患儿LCSF－Ft含量明显高于其它组（P均＜0．01）。10例中枢神经系统白血病患儿，随病情好转其CSF－Ft水平渐下降。结论CSF－Ft检测对中枢神经系统白血病诊断有重要价值，并可做为评价中枢神经系统白血病治疗效果的重要指标。