白血病患者鞘内注射化疗药物后急性截瘫六例临床分析

Abstract

目的 探讨鞘内注射化疗药物后发生急性截瘫的病因、可能的发生机制以及影响预后的因素,为及时诊断、治疗及预防提供帮助.方法 收集2015年1月1日至2017年6月1日在北京大学人民医院住院的鞘内注射化疗药物后出现急性截瘫的白血病患者6例,总结其临床表现、影像学及脑脊液检查等结果.结果 6例患者平均年龄27.3(7～ 55)岁,4例鞘内注射阿糖胞苷(Ara-c),2例鞘内注射Ara-c联合甲氨蝶呤(MTX).5例患者在鞘内注射过程中或结束时出现截瘫,1例患者在注射后出现疼痛,2h后出现截瘫.4例完成了脊髓磁共振扫描,均未发现责任病灶.年龄小、给药总剂量大、鞘内注射次数多、联合用药者症状重,病程长.结论 Ara-c与急性截瘫的发生关系密切,患者年龄、给药总剂量、给药次数与病情严重程度和预后相关.

Objective To investigate the potential pathogenesis of acute paraplegia resulting from intrathecal chemotherapy and to analyze the factors influencing prognosis.Methods Six cases presented with acute paraplegia after intrathecal chemotherapy for leukemia from January 1 st,2015 to June 1st,2017 in our hospital.The patients' clinical manifestation,data of imaging and cerebrospinal fluid were analyzed.Result Six patients with leukemia were with an average age of 27.3 (7 to 55) years old.Four cases were intrathecally injected with cytarabine,and two cases were intrathecally injected with cytarabine and methotrexate.Paraplegia occurred in 5 patients during or immediately after the injection;pain occurred in 1 patient immediately after the injection followed with paraplegia 2 h later.Four patients underwent MRI scan of the spinal cord but failed to show responsible lesions.The youngest patient who received the most frequent intrathecal injections,the highest dosage of cytarabine,combination with methotrexate set up the most serious symptoms and the poorest prognosis.Conclusions Cytarabine has close relationship with the occurrence of paraplegia.The possible risk factors of poor prognosis might be younger age,more frequent injections,higher dosage,combination of cytarabine and methotrexate.