CAJ | 학술논문

目的分析血液病相关颅内出血(ICH)的临床和影像学特点,提高临床医师的认识.方法 1998年1月至2010年5月发生的与原发血液病相关的ICH病例31例,回顾性分析其基础疾病、临床和影像学表现以及导致死亡的危险因素.结果发生ICH的血液病以急性髓细胞白血病(AML)、特发性血小板减少性紫癜(ITP)多见,分别为13例和6例,多表现为头痛、烦躁、恶性呕吐和意识障碍,缺乏定位体征,影像学表现以渗血为主,CT与MRI诊断的符合率为60%(3/5),头颅MRI的ICH检出率高于CT.总病死率为71%(22/31),发热、白细胞＞5×109/L、血小板＜50×109/L、免疫球蛋白增高、凝血功能异常、全身多部位出血等是ICH的危险因素,具备≥2个危险因素者病死率为86.4%(19/22),显著高于有≤1个危险因素的患者病死率[33.3%(3/9)](x2=8.718,P=0.003).结论血液病相关ICH是威胁患者生命的严重并发症,头颅MRI有助于提高血液病相关ICH诊断率,发热、白细胞＞5×109/L、血小板＜50×109/L、免疫球蛋白增高、凝血功能异常等多种危险因素并存可导致血液病ICH患者死亡率增加.
목적 분석혈액병상관로내출혈(ICH)적림상화영상학특점,제고림상의사적인식.방법 1998년1월지2010년5월발생적여원발혈액병상관적ICH병례31례,회고성분석기기출질병、림상화영상학표현이급도치사망적위험인소.결과 발생ICH적혈액병이급성수세포백혈병(AML)、특발성혈소판감소성자전(ITP)다견,분별위13례화6례,다표현위두통、번조、악성구토화의식장애,결핍정위체정,영상학표현이삼혈위주,CT여MRI진단적부합솔위60%(3/5),두로MRI적ICH검출솔고우CT.총병사솔위71%(22/31),발열、백세포＞5×109/L、혈소판＜50×109/L、면역구단백증고、응혈공능이상、전신다부위출혈등시ICH적위험인소,구비≥2개위험인소자병사솔위86.4%(19/22),현저고우유≤1개위험인소적환자병사솔[33.3%(3/9)](x2=8.718,P=0.003).결론 혈액병상관ICH시위협환자생명적엄중병발증,두로MRI유조우제고혈액병상관ICH진단솔,발열、백세포＞5×109/L、혈소판＜50×109/L、면역구단백증고、응혈공능이상등다충위험인소병존가도치혈액병ICH환자사망솔증가.
Objective To analyze clinical and radiological characteristics of intracranial hemorrhage in hematological diseases to improve the recognition of them. Methods Thirty-one clinical data of intracranial hemorrhage cases with hematological diseases were reviewed. The basic diseases, clinical and radiological manifestations, and risk factors of mortality were analyzed. Results Intracranial hemorrhage usually occurred in patients with acute myeloid leukemia (AML) or idiopathic thrombocytopenic purpura (ITP),and 13 and 6 cases, respectively, in this group. Most patients presented with headache, restlessness, nausea,vomiting, conscious disturbance and no localization sign by physical examination. CT or MRI images often revealed focus of errlysis. Compared with CT scan, a higher detection rate of ICH could be realized by MRI scan. The total mortality in this group of ICH patients was 71% (22/31). Fever, white blood cell ＞5×109/L,platelet ＜50×109/L, hyperimmunoglobulinemia and disturbance of blood coagulation were risk factors for ICH of this group of patients. The mortality was higher in patients with no less than 2 risk factors[86.4 % (19/22)vs 33.3 % (3/9)] (x2 = 8.718, P = 0.003). Conclusion ICH is a serious complication for hematological patients. MRI scan is good at improving the diagnosis of ICH. It is of high risk of death in patients with no less than 2 risk factors such as fever, white blood cell higher than 5×109/L, platelet less than 50×109/L,hyperimmunoglobulinemia and disturbance of blood coagulation.