Robertson T I
Westmead Hospital, NSW, Australia.
Aust N Z J Med. 1990 Feb;20(1):44-50. doi: 10.1111/j.1445-5994.1990.tb00370.x.
The complications and causes of death of 105 patients with B cell chronic lymphocytic leukaemia followed for a median period of 5.5 years are described. Infection and secondary primary malignant tumours were the most common complications and also caused most deaths. S. pneumoniae, S. aureus, S. haemolyticus, E. coli and the zoster-varicella virus accounted for most infections and the lungs, skin and urinary tract were the sites affected. Even trivial infections were potentially serious. Haemolytic anaemia and vascular complications were also common. Older patients tended to have a shorter survival than the mean for the group whereas younger patients fared better. The mean survival was 6.2 years. Analysis confirmed the prognostic value of Rai staging. Advancing disease increased the liability to major infection. Light bone marrow infiltration five years post diagnosis indicated a good prognosis and preservation of normal immunoglobulin levels seemed beneficial. Immunoglobulin deficiency is the factor that correlates best with the frequency, severity and pattern of infection. Early stage disease provides a distinct benefit and there may be advantages in prompt diagnosis, regular assessment by immunoglobulin levels and bone marrow pattern and treatment on the first evidence of advancing disease. Fresh symptoms should be investigated in their own right because of the likelihood of second tumours.
本文描述了105例B细胞慢性淋巴细胞白血病患者的并发症和死亡原因，这些患者的中位随访时间为5.5年。感染和继发性原发性恶性肿瘤是最常见的并发症，也是导致死亡的主要原因。肺炎链球菌、金黄色葡萄球菌、溶血葡萄球菌、大肠杆菌和带状疱疹-水痘病毒是大多数感染的病原体，感染部位主要是肺部、皮肤和泌尿系统。即使是轻微感染也可能很严重。溶血性贫血和血管并发症也很常见。老年患者的生存期往往短于该组的平均生存期，而年轻患者的情况较好。平均生存期为6.2年。分析证实了Rai分期的预后价值。疾病进展增加了发生严重感染的可能性。诊断后五年骨髓轻度浸润表明预后良好，维持正常免疫球蛋白水平似乎有益。免疫球蛋白缺乏是与感染频率、严重程度和模式相关性最好的因素。早期疾病有明显优势，早期诊断、定期通过免疫球蛋白水平和骨髓模式进行评估以及在疾病进展的首个证据出现时进行治疗可能具有益处。由于存在发生第二种肿瘤的可能性，对于新出现的症状应单独进行调查。
