Abstract:

Objective    To explore the differential diagnostic significance of cerebrospinal fluid（CSF） detection with flow cytometry（FCM） technology in children with acute lymphoblastic leukemia（ALL） accompanied by central nervous system diseases. Methods    Seven CSF samples of children with ALL were detected by FCM，cell morphology，CSF routine tests and biochemical examination in Department of Pediatrics，the First Affiliated Hospital，Sun Yat-sen University from February 2009 to February 2014. The children were treated and followed-up. The comparison between FCM and traditional methods in the diagnosis of ALL accompanied with encephalopathy was made. Results    According to the traditional methods，only two patients were diagnosed reliably with CNSL，and in the other five patients，the initial diagnosis （CNSL or non-CNSL） was equivocal. But according to the results of FCM，four patients were diagnosed with CNSL，and three of them had acquired complete remission after systemic and intrathecal chemotherapy. One patient died because of disease progression. Two patients， who were diagnosed with viral meningitis， improved rapidly after treatment with acyclovir. One patient was finally diagnosed with reactive meningitis disease， because the cerebrospinal fluid gradually returned to normal without treatment and the follow-up was uneventful. Conclusion    FCM is a highly sensitive technique capable of accurately detecting malignant cells. It is an important supplement to CSF routine detections，and has significant application value in differential diagnosis of ALL children accompanied by central nervous system diseases.

摘要：

目的    探讨儿童急性淋巴细胞白血病（ALL）并发中枢神经系统（CNS）疾病时脑脊液流式细胞学（FCM）检测技术的鉴别诊断价值。方法　采用FCM技术、脑脊液常规细胞形态学、脑脊液常规和生化检测对2009年2月至2014年2月在中山大学附属第一医院（包括东院）儿科住院的7例脑脊液淋巴细胞数增多的ALL患儿脑脊液标本进行检测，并对患儿进行治疗追踪，比较FCM与传统方法在诊断ALL并脑病时的差别和准确性。结果　按照传统细胞形态学方法，2例诊断为CNS白血病（CNSL），其余诊断不确定；依据FCM检测结果，7例患儿中诊断CNSL 4例，诊断非白血病浸润性疾病3例，通过治疗和追踪，后者确诊病毒性脑膜炎2例，反应性脑膜炎1例。确诊CNSL的4例患儿经过全身和鞘注化疗，1例因疾病进展死亡，其余3例均已获得缓解；2例病毒性脑膜炎患儿经阿昔洛韦治疗病情迅速改善；1例反应性脑膜炎患儿未经治疗，脑脊液逐步恢复正常。结论　脑脊液FCM技术敏感度高，可以提供客观、更精确的判断依据，是脑脊液细胞形态学检测方法的重要补充，在儿童ALL并发CNS疾病的鉴别诊断中有重要价值。