全省各大醫院小兒急性白血病的臨床觀察尤其生存期間的考察

Clinical Observation on Children with Acute Leukemia: The Influence of Clinical Factors on Survival

林守田(Shuo-Tien Lin)

《Acta Paediatrica Sinica》 9卷4期 (1968/12) Pp. 172-181

摘要

由全省各大醫院小兒科與血液科收集小兒急性白血病的病例共146人做臨床統計觀察。於6歲與9歲的年令有兩個頂點，男女比率為1.8:1，淋巴性(47.3%)比骨髓性(24.7%)多，家長職業多屬不富裕的家庭，初診時主要症狀為蒼白(80%)，肝腫(70.4%)，熱(69.6%)，脾腫(60)，淋巴腺腫(45.6%)，出血(63.2%)。血紅素9gm以下(81.7%)，血小板10萬以下(71.3%)，白血球10,000以下(30.3%)，骨髓檢查都有白血病細胞的浸潤，出血時間有延長的76.9%，凝固時間有延長的4.1%而已。自1961年以後大部分病人以Steroid，6-mercaptopurine， methotrexate治療。
生存期間，36人的6個月以上生存百分率19.4%，其median survival time為1.2個月（自診斷確定日算起）。觀察6個月以上生存者的臨床症狀與檢驗成績得到如下結果。小兒急性白血病病人之中其病情若是1．淋巴性，2．臨床症狀少，輕，3．初診時白血球數沒有增加，4．末梢血中白血病細胞少，5．貧血輕度，6．血小板無顯著減少，7．有合理而適當的化學療法，則長期生存的機會較多。

並列摘要

Clinical observation on 146 children with acute leukemia on pediatric services and hematologic sections of general hospitals in Taiwan was made. The age incidence showed two peaks at 6 years and 9 years. The ratio of males to females was 1.8 to 1. The lymphatic type (47.3%) was more than the myelocytic type (24.7). Most of the patient's fathers were public officers and labouring men, therefore many of the patients occurred among those in the middle to lower socio-economic groups. The initial clinical manifestations were pallor (80%), hepatomegaly (70.4%), fever (69.6%), splenomegaly (60%), lymphadenopathy (45.6%), and hemorrhagic manifestations (63.2%). The hemoglobin level was less than 9 gm/100 ml in 81.7% of the patients, and 71.3% of the patients whose platelet counts were below I00,000/cmm, a leukocyte count below 10,000/cmm was seen in 30.3% of the patients. All of the patients had leukemic changes in their bone marrow. About 76.9% of the patients had prolonged bleeding times, and 4.1% of the patients had prolonged coagulation times. Since 1961 most of the patients were treated with steroids, 6-m-p and methotrexate.
We were able to observe the survival time in 36 patients, their 6 months survival rate was 19.496, the median survival time was 1.2 months which was calculated from the time of clinical diagnosis. Data was also collected following the observation of clinical and laboratory findings which developed in patients who survived 6 months or longer. It appears that if the patient with acute leukemia has the clinical and laboratory findings as follows he could survive longer. These are the clinical manifestations of lymphatic leukemia; mild or absent hepatosplenomegaly, lymphadenopathy, hemorrhagic tendency and fever; the initial leukocyte count shouldn't increase or leukopenia; there should be no remarkable decrease in platelets and mild anemia; there are only a few leukemic cells in peripheral blood.