【摘要】 目的 分析中枢神经系统受累的急性淋巴细胞白血病患儿发病情况及治疗方法，为改善患儿预后提供借鉴资料。方法 回顾性分析急性淋巴细胞白血病患儿130例临床资料，其中中枢神经系统受累27例，比较中枢神经系统受累与未受累患儿的年龄、性别、初诊外周血白细胞计数、脑脊液细胞形态学分型、临床危险度分型、免疫学分型情况，分析判定急性淋巴细胞白血病患儿发生中枢神经系统受累的影响因素。结果 急性淋巴细胞白血病患儿中枢神经系统受累发生率为20.8%,中枢神经系统受累与未受累患儿的年龄、性别、脑脊液细胞形态学分型比较差异无统计学意义(P>0.05),初诊外周血白细胞计数、临床危险度分型、免疫学分型比较有统计学意义(P<0.05),logistic回归分析提示：初诊外周血白细胞计数、临床危险度分型、免疫学分型是急性淋巴细胞白血病患儿发生中枢神经系统受累的影响因素。27例中枢神经系统受累的急性淋巴细胞白血病患儿均接受全身化疗及鞘内注射联合治疗，其中9例接受大剂量甲氨蝶呤化疗，6例异基因外周造血干细胞移植，接受放疗5例。所有患者中随访半年失访2例，存活17例，死亡8例。结论 急性淋巴细胞白血病患儿在初诊和化疗过程中均可能发生中枢神经系统受累，其受到患儿初诊外周血白细胞计数、临床危险度分型、免疫学分型的影响。临床上多采用化疗及鞘内注射联合治疗，患儿预后不容乐观，应积极探讨更佳的防治对策，改善预后。更多还原

【Abstract】 Objective To study the incidence and treatment outcome of acute lymphoblastic leukemia in children with central nervous system involvement, and to provide reference data for improving the prognosis of children.Methods 130 children with acute lymphoblastic leukemia diagnosed and treated were collected and their clinical data were retrospectively analyzed, among them, 27 cases of central nervous system involvement, the age, gender, newly diagnosed peripheral blood white blood cell count, cerebrospinal fluid cell morphology classification, clinical risk classification and immunological classification of children with and without central nervous system involvement were compared, the above items whether or not the influencing factors of central nervous system involvement in children with acute lymphoblastic leukemia were determined through statistical analysis, the treatment plan for children with acute lymphoblastic leukemia with central nervous system involvement and the treatment effect were observed and recorded.Results In this study, the incidence of central nervous system involvement in children with acute lymphoblastic leukemia was 20.8%,there was no significant difference in age, gender, and morphological type of cerebrospinal fluid between children with and without central nervous system involvement(P>0.05),there were statistically significant differences in peripheral blood white blood cell count, clinical risk classification, and immunological classification(P<0.05),logistic regression analysis indicated that the newly diagnosed peripheral blood white blood cell count, clinical risk classification and immunological classification were the influencing factors of central nervous system involvement in children with acute lymphoblastic leukemia.27 children with acute lymphoblastic leukemia with central nervous system involvement were treated with systemic chemotherapy and intrathecal injection, among them, 9 cases received high-dose methotrexate chemotherapy, 6 cases received allogeneic peripheral hematopoietic stem cell transplantation, and 5 cases received radiotherapy.Among all patients, 2 cases were lostto follow-up for half a year, 17 cases survived and 8 cases died.Conclusion Children with acute lymphoblastic leukemia may have central nervous system involvement during the initial diagnosis and chemotherapy, it is affected by the peripheral blood white blood cell count, clinical risk classification and immunological classification of the child.In clinical practice, chemotherapy and intrathecal combined injection therapy are often used for treatment, the prognosis of children is not optimistic, and better prevention and treatment strategies should be actively explored to improve the prognosis.更多还原