妊娠合并急性早幼粒细胞白血病一例并文献复习

Pregnancy with Acute Promyelocytic Leukemiain 1 Case and the Literature Review

摘要: 目的：探讨妊娠期白血病的临床特点及处理，以提高该疾病的诊疗水平，改善母婴结局。方法：回顾性分析青岛大学医学院附属医院收治的1例妊娠合并急性早幼粒细胞白血病患者的诊治过程及其预后，并结合相关文献对该疾病进行分析。结果：本例患者32岁，于妊娠晚期发现急性早幼粒细胞白血病，给予输注血小板、冷沉淀、红细胞改善血常规、血凝，促胎肺成熟、硫酸镁抑制宫缩、预防感染等治疗等对症处理，术前即开始维甲酸化疗，于妊娠29周行剖宫产娩出一活女婴，术后进行常规化疗。因在孕早期对妊娠期白血病患者化疗导致胎儿畸形和流产概率高，所以建议终止妊娠后治疗；妊娠中晚期暴露于化疗药物会增加胎儿生长受限、早产、新生儿中性粒细胞减少和败血症的风险，但并不增加胎儿畸形的风险，可根据孕周大小制定最佳治疗方案。结论：妊娠期间合并急性早幼粒细胞白血病发生率较低，但处理棘手，需要临床多学科综合治疗，根据患者所处妊娠阶段、意愿及白血病状态选择最佳的治疗时机及治疗方案以改善母婴不良结局。

Abstract: Objective: To investigate the clinical features and treatment of leukemia during pregnancy, in order to improve outcome of mother and child. Methods: The diagnosis and treatment process and prognosis of 1 case of pregnancy complicated with acute promyelocytic leukemia in affiliated hospital of Qingdao University Medical College were analyzed retrospectively. Results: The patient was 32 years old and found acute promyelocytic leukemia in the third trimester of pregnancy. The patient was treated with platelet transfusion, cryoprecipitation, red blood cell improvement, hemagglutination, fetal lung maturation, magnesium sulfate inhibition of uterine contraction, anti-inflammatory and so on. Routine chemotherapy was performed after operation. The literature shows that the first three months of pregnancy are the stages of fetal organ formation and development, so the risk of abortion and fetal malformation is high. Leukaemia found in early pregnancy should be treated with routine leukemia immediately after termination of pregnancy; exposure to chemotherapeutic drugs in late pregnancy increases the risk of fetal growth restriction, preterm birth, neonatal neutropenia, and septicemia, but does not increase the risk of fetal malformation. The best treatment plan can be developed according to week of gestation. Conclusion: The incidence of acute promyelocytic leukemia during pregnancy is low, but it is difficult to deal with. It is necessary for multidisciplinary comprehensive team cooperation to choose the best treatment time and plan to reduce the incidence of outcome of mother and child, according to the pregnancy stage, willingness and leukemia state.