小儿类白血病反应的临床分析

目的:回顾性分析小儿类白血病反应(LR)患者的临床特点。方法:8例26天-2岁患儿资料,对其发病诱因、临床表现、实验室检查和治疗转归进行总结分析。结果:本组患儿全部以感染为诱发因素,包括百日咳2例,类百日咳综合征2例,病毒感染2例,细菌感染2例;均有肺炎表现、心率明显增快140-220次/min,平均173±22次/min,其中5例为痉挛性、刺激性咳嗽,且咳嗽时伴青紫和心率下降;全部患儿白细胞计数(WBC)明显升高58.00-213.60×109/L,平均104.50±60.10×109/L。所有患儿均采用抗生素治疗,部分患儿应用呼吸机或持续呼气末正压通气治疗,WBC过高者给予补液治疗,2例合并使用抗病毒治疗。病程中发生反复呼吸、心跳骤停3例;并发中毒性脑病3例;痊愈6例,死亡2例。结论:感染为小儿LR的主要诱因,其临床表现较严重,抗生素治疗有效,多数病例可以治愈。

A Clinical Analysis of Children with Leukemoid Reaction

Objective：To retrospectively analyze the clinical characteristics of children with leukemoid reaction （LR）.Meth-od：8 cases were collected in our hospital the age ranged from 26 days to 2 years.The predisposing factors,clinical manifestations,laboratory examination and treatment outcomes were summarized and analyzed.Results：Infection as a predisposing cause.This group of children including 2 cases of pertussis,2 cases of whooping cough syndrome,2 cases of viral infection,2 cases of bacterial infection.All patients had the symptom of pneumonia and the heart rate increased significantly to 140-220 （173 ± 22）/min.5 cases had the symptom of spastic,irritating cough,and cough with cyanosis and heart rate decrease.In all cases,the white blood cells were increased to 58.00-213.60 （104.50± 60.10）×10^9/L.All of the cases were treated with antibiotics and 2 case were also with antiviral drugs. Some cases had application of ventilator or end expiratory positive pressure ventilation in the treatment of LR.Fluid therapy was given when WBC was too high.Repeated breathe-cardiac arrest occurred in 3 cases during the course of the disease;3 cases complicated with toxic encephalopathy.In this group,6 cases were cured and 2 cases were dead. Conclusion：Infection was the main cause of LR in children which clinical manifestation is serious and could be cured with antibiotics therapy in most cases.