儿童急性白血病肝功能损害及临床意义

为了研究白血病化疗过程中肝功能损害的病因，测定了56例急性白血病化疗前后肝功能，并提出了药物性肝脏损害及白血病细胞肝脏浸润的诊断方法。56例患儿中36例（64．3％）有肝功能受损，其中29例43例次发生药物性肝脏损害，白血病肝浸润9例，2例肝浸润时均无骨髓、中枢等复发证据。4例发生病毒性肝炎。对不同类型肝损害进行治疗，各种肝脏损害恢复时间平均为：药物性8．1天，白血病肝浸润7天，病毒性肝炎30天。结果表明：急淋患儿在诱导及强化治疗过程中易发生药物性肝炎，左旋门冬酰氨酶是引起药物性肝炎最主要药物，其次是6-巯基嘌呤、甲氨喋呤；肝脏可能是急淋白血病的庇护所，环磷酰胺试验治疗对肝脏浸润早期诊断具有重要诊断价值。

LIVER DAMAGE IN CHILDREN WITH ACUTE LEUKEMIA AND ITS CLINICAL SIGNIFICANCE

The etiology of liver damage was investigated in 56 patients with acute leukemia, liverfunction was tested before chemotherapy and then it was finished. The criteria of liver disfunction inducded by both antileukemia agents and infiltrition of leukemic cells were defined.36 patients were observed to have liver disfunction, among them, 29 patients were due todrug toxicity, 4 patients caused by viral hepatitis, 9 patients related to the infiltrition of liverby leukemic cells, of which 2 patients were proved to have no proof of central nervous system and bone marrow involvement, all kinds of liver damage were treated. Our resultsshowed that patients with acute lymphoblastic leukemia were commonly associated with liverdamage durintg induction and intensification therapy, L-asparaginase is the chief drug thatcauses liver damage, the others are 6-mercaptopurine and methotrexate. The liver may bethe sanctuary site of acute lymphoblastic leukemia. Cyclophosphamide is of important valueto the diagnosis of early infiltration of the liver by leukemic cells.