- 期刊
急性淋巴性白血病兒在抗癌治療中併發間質性肺炎之臨床研究
Clinical Study of Interstitial Pneumonia in Acute Lymphoblastic Leukemia Children under Anti-cancer Therapy
摘要
高雄醫學院小兒科從 1981 年 l 月至 1985 年 8 月間共經歷了 49 例接受抗癌治療之急性淋巴性白血病兒，其中 8 例在治療期中發生間質性肺炎， 3 例不治死亡，其肺炎併發率為 16 . 3 % ，併發肺炎者之死亡率為 37 . 5 ％。 8 例之胸部 X 光攝影均有兩側廣泛性肺部浸潤。從開始治療到併發間質性肺炎之期間為 2 到 6 個月，平均為 2 . 5 個月。在緩解期發生者有 7 例，只有 l 例是在引導治療時發生。最常見之臨床表現是發燒（ 8 /8 ) ，呼吸急促與呼吸困難（ 8 / 8 ) ，而以聽診無囉音為特徵（ 8 / 8 ）。其他症狀如咳嗽（ 7 / 8 ) ，鼻翼擴張（ 3 / 8 ) ，發紺（ 2 / 8 ）等亦可見。第 3 例曾做肺部針吸病理切片檢查證實為肺抱子蟲感染（ Pneumocystis carinii infection）。臨床上以氧氣、抗生素、 trimethoprim - sulfamethoxazole ( TMP - SMZ ）治療，結果 3 例死亡， 5 例在 7 天內症狀緩解。 雖然直接由病理證實肺抱子蟲感染者只有 1 例，但有 5 例經抗生素治療無效後以 TMP - SMZ 治療，結果其症狀均在 3 到 5 天內改善，由此可間接推想為肺孢子蟲感染之可能性。間質性肺炎是急性淋巴性白血病兒治療中重要之併發症及死因之一，對任何發燒或呼吸急捉的白血病兒應密切注意。早期診斷、早期治療對白血病兒之存活率將會有莫大的幫助。
關鍵字
無資料並列摘要
Interstitial pneumonia is a serious infectious complication of leukemia phtients under anti-cancer therapy. The common pathogens could be virus and Pneumocystis carinil or complications from radiothcrapy. Eight of forty-nine ALL cases accompanied with interstitial pneumonia were studied during the period from Jan. 1981 to Aug. 1985 with a morbidity rate of 1 6.3% and a mortality rate of 37.5% (3/8). The most common clinical manifestations were sudden onset of fever (8/8), dyspnea 8), cough (7/8), nasal flaring (3/8) and cyanosis (2/8), with a characteristic sign of bilateral diffuse pulmonary infiltrates on chest X-rays without any moist rale on auscultation. Lung biopsy was performed in one case, P. carinii infection was discovered. Seven of the eight cases occurred during remission and only one case was noted during induction. The intervals between chemotherapy and onset of pneumonia ranged from 2 to 6 months. They were treated with trimethoprimsulfamethoxazole, sometimes combined with antibiotics. Three cases died and five cases recovered. Early diagnosis and treatment or even prophylaxis for P. carinii infection may be very important in curing immunocompromised patients of this disease.