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近年来由于采用联合化疗,白血病的疗效提高,患儿生存期延长,但抗白血病药物多不能有效地通过血脑屏障,使中枢神经系统成为白血病细胞的贮藏站,而导致白血病的复发。因此脑膜成中枢神经系统的白血病浸润起来越成为重要问题。据国外报道脑膜白血病的发生率可达50％。两年来我院白血病住院病人中有5例脑膜白血病,占同期白血病住院人数的7.7％。中枢神经系统白血病的发生距发病时间一般为5月-2年,我院平均为9.8月。病变可发生于蜘蛛膜、脑实质和脊髓实质。症状主要为颅压增高,因浸润的部位不同还可有颅神经和脊髓神经的症状,如吞咽困难,言语障碍,感觉障碍等。眼底检查多有视神经乳头水肿。年幼小儿颅骨x线检查可有颅缝裂开。脑脊液检查力增高,外观因细胞数的不同而有清或微混,细胞数增压高,以原始和幼稚细胞为主,蛋白增多,糖减低。预防化的鞘内注射MTY或口服乙胺嘧啶可减少中枢神经系统白血病的发生率。MTX 0.4毫克/公斤/次或Ara-C25毫克/平方米/次,隔日一次鞘内注射,对脑膜病的疗效显著,但还可很快复发,应同时加用颅骨和脊髓之X线照射。
In recent years, due to the use of combination chemotherapy, leukemia improved efficacy, prolonged survival in children, but many anti-leukemia drugs can not effectively through the blood-brain barrier, the central nervous system has become a leukemia cell storage station, leading to the recurrence of leukemia. Therefore, the meningeal leukemia into the central nervous system more and more become an important issue. According to foreign reports, the incidence of leukemia up to 50%. In the past two years, 5 leukemia patients with leukemia in our hospital had leukemia, accounting for 7.7% of the leukemia hospitalizations in the same period. The occurrence of central nervous system leukemia from the onset time is generally May - 2 years, our hospital average of 9.8 months. Lesions can occur in the arachnoid, brain parenchyma and spinal parenchyma. The main symptoms of increased intracranial pressure, due to different parts of the infiltration can also have cranial nerves and spinal cord nerve symptoms, such as dysphagia, speech disorders, sensory disturbances. Fundus examination and more papilledema. Young children skull x-ray examination may have craniosynostosis. Cerebrospinal fluid examination increased, the appearance of cells due to the number of different clear or micro-mixed, cell number increased pressure, mainly naive and naive cells, increased protein, reducing sugar. Preventive intrathecal MTY or oral pyrimethamine can reduce the incidence of central nervous system leukemia. MTX 0.4 mg / kg / time or Ara-C25 mg / m2 / time, once every other day intrathecal injection of significant effect on meningeal disease, but also can be a relapse soon, should also be added with skull and spinal cord X-ray irradiation.