ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2023, Vol. 15 ›› Issue (6): 531-535.

• 临床研究 • 上一篇    下一篇

儿童类白血病反应临床特点分析

  

  • 出版日期:2023-12-25 上线日期:2024-03-06

Analysis of the clinical characteristics of leukemoid reaction in children

  • Published:2023-12-25 Online:2024-03-06

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摘要： 目的 探讨儿童类白血病反应(LR)临床特点及与白血病鉴别要点。方法 回顾性分析湖南省儿童医院内科综合病房近两年收治的89例血常规白细胞计数(WBC)≥30×109/L患者临床资料，选取同期入院的89例WBC<30×109/L患者作为对照组(NLR组),统计分析两组一般资料、实验室检查、住院时间、出院诊断等临床资料，并对比分析WBC≥30×109/L患者中类白血病组(LR组)与白血病组实验室指标差异。结果 WBC≥30×109/L组较对照组发热患者比例更高，住院时间更长，中性粒细胞比值更高，血培养阳性率更高，WBC≥30×109/L组中除白血病外，最主要诊断为肺炎，两组肺实变发生率比较差异有统计学意义(P<0.05),菌血症患者中革兰阳性菌感染率更高(P<0.05)。WBC≥30×109/L患者中类白血病反应44例，白血病45例，白血病组白细胞计数≥50×109/L患者占比显著高于LR组，白血病组与LR组在实验室指标血小板计数、C反应蛋白、尿酸和乳酸脱氢酶水平比较差异有统计学意义(P<0.05)。结论 以类白血病反应为表现的患儿通常有明确的病因，肺炎、肺实变发生风险高，综合临床特点及实验室指标有助于在白细胞增高患者中早期识别白血病。

关键词: 类白血病反应, 白细胞增多, 白血病, 肺实变, 菌血症

Abstract: ObjectiveTo explore the clinical features of leukemoid reaction (LR) in children and the key points of differentiation from leukemia.MethodsThe clinical data of 89 children with leukocyte ≥30×109/L admitted to the internal medicine ward of Hunan Children's Hospital in the past two years (LR group) were retrospectively analyzed,including 44 cases of leukemoid reaction and 45 cases of leukemia.Another 89 children with non-leukemoid reaction(leukocyte <30×109/L) admitted in the same period were selected as the control group(NLR group).The general data,laboratory examination,hospital stay,discharge diagnosis and other clinical data of LR group and control group were statistically analyzed.The difference in laboratory indexes between LR group and leukemia group was compared.ResultsCompared with the non-leukemoid reaction(NLR) group,the ≥30×109/L group had a higher proportion of fever patients,longer hospital stay,higher neutrophil ratio and higher positive rate of blood culture.Pneumonia was the main diagnosis in the LR group,and the incidence of lung consolidation was statistically different between the two groups(P<0.05).The LR group in bacteremia patients had a higher gram-positive infection rate.The proportion of patients with leukocyte count ≥50×109/L in leukemia group was significantly higher than that in LR group,and there were statistically significant differences in platelet count,C-reactive protein,uric acid and lactate dehydrogenase levels between leukemia group and LR group.ConclusionChildren with LR usually have a clear etiology and are at high risk for pneumonia and lung consolidation.A combination of clinical features and laboratory indicators can help early identification of leukemia in patients with leukocytosis.

Key words:

Leukemioid reaction, Leukocytosis, Leukemia, Lung consolidation, Bacteremia