Howard Scott C, Gajjar Amar J, Cheng Cheng, Kritchevsky Stephen B, Somes Grant W, Harrison Patricia L, Ribeiro Raul C, Rivera Gaston K, Rubnitz Jeffrey E, Sandlund John T, de Armendi Alberto J, Razzouk Bassem I, Pui Ching-Hon
Department of Hematology/Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
JAMA. 2002;288(16):2001-7. doi: 10.1001/jama.288.16.2001.
Traumatic or bloody lumbar puncture (LP) reduces the diagnostic value of the procedure and may worsen the outcome of patients with acute lymphoblastic leukemia (ALL). Little is known about the risk factors for traumatic and bloody LP.
To determine the risk factors for traumatic and bloody LP.
DESIGN, SETTING, AND PATIENTS: Retrospective cohort study of 956 consecutive patients with newly diagnosed childhood ALL who were treated at a pediatric cancer center between February 1984 and July 1998.
All patients underwent a diagnostic LP followed by a median of 4 LPs to instill intrathecal chemotherapy.
Traumatic LP was defined as an LP in which cerebrospinal fluid contained at least 10 red blood cells (RBCs) per microliter and bloody LP as one in which the cerebrospinal fluid contained at least 500 RBCs per microliter.
Of the 5609 LPs evaluated, 1643 (29%) were traumatic and 581 (10%) were bloody. The estimated odds ratios (ORs) and 95% confidence intervals (CIs) for traumatic LP were 1.5 (95% CI, 1.2-1.8) for black vs white race, 2.3 (95% CI, 1.7-3.0) for age younger than 1 year vs 1 year or older, 1.4 (95% CI, 1.2-1.7) for early vs recent (dedicated procedure area and general anesthesia) treatment era, 1.5 (95% CI, 1.2-1.8) for platelet count of 100 x 10(3)/ microL or more vs less than 100 x 10(3 )/ microL, 10.8 (95% CI, 7.7-15.2) for short (1 day) vs longer (>15 days) interval since the previous LP, and 1.4 (95% CI, 1.1-1.8) for the least vs the most experienced practitioners. Analyses for bloody LP yielded similar results.
The unmodifiable risk factors for traumatic and bloody LP include black race, age younger than 1 year, a traumatic or bloody previous LP performed within the past 2 weeks, and a previous LP performed when the platelet count was 50 x 10(3)/ microL or less. Modifiable risk factors include procedural factors reflected in treatment era, platelet count of 100 x 10(3)/ microL or less, an interval of 15 days or less between LPs, and a less experienced practitioner.
创伤性或血性腰椎穿刺（LP）会降低该检查的诊断价值，且可能使急性淋巴细胞白血病（ALL）患者的预后恶化。关于创伤性和血性LP的危险因素知之甚少。
确定创伤性和血性LP的危险因素。
设计、地点和患者：对1984年2月至1998年7月在一家儿科癌症中心接受治疗的956例新诊断的儿童ALL连续患者进行回顾性队列研究。
所有患者均接受了诊断性LP，随后平均进行4次LP以注入鞘内化疗药物。
创伤性LP定义为脑脊液中每微升至少含有10个红细胞（RBC）的LP，血性LP定义为脑脊液中每微升至少含有500个RBC的LP。
在评估的5609次LP中，1643次（29%）为创伤性，581次（10%）为血性。创伤性LP的估计比值比（OR）及95%置信区间（CI）为：黑人与白人相比为1.5（95%CI，1.2 - 1.8）；年龄小于1岁与1岁及以上相比为2.3（95%CI，1.7 - 3.0）；早期与近期（专用操作区域和全身麻醉）治疗时代相比为1.4（95%CI，1.2 - 1.7）；血小板计数为100×10³/微升或更高与低于100×10³/微升相比为1.5（95%CI，1.2 - 1.8）；自上次LP后间隔短（1天）与长（>15天）相比为10.8（95%CI，7.7 - 15.2）；经验最少与经验最丰富的从业者相比为1.4（95%CI，1.1 - 1.8）。血性LP的分析得出类似结果。
创伤性和血性LP的不可改变的危险因素包括黑人种族、年龄小于1岁、过去2周内进行过创伤性或血性LP以及上次LP时血小板计数为50×10³/微升或更低。可改变的危险因素包括治疗时代所反映的操作因素、血小板计数为100×10³/微升或更低、LP之间间隔15天或更短以及经验较少的从业者。
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