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围生期噬血细胞性淋巴组织细胞增生症的临床诊断与治疗

[Clinical diagnosis and treatment of perinatal stage hemophagocytic lymphohistiocytosis].

作者信息

Zhang B B, Song Y, Wang Z

机构信息

Department of Hematology, People's Hospital of Yinzhou, Ningbo 315100, China.

Department of Hema-tology, Beijing Friendship Hospital, Beijing 100050, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2019 May 14;40(5):384-387. doi: 10.3760/cma.j.issn.0253-2727.2019.05.007.

Abstract

To analyze the clinical features of patients with hemophagocytic lymphohistiocytosis (HLH) during perinatal stage. From January 2011 to October 2016, the obstetric materials, clinical features, associated disease/factors and therapeutic outcomes were studied in 11 patients with HLH in perinatal period. In these 11 patients, 9 were primipara. As for the onset time of HLH, 5 were before delivery and 6 were after delivery. Six were complicated with other associated disease/factors, and infection was the commonest (5/6) . Treatment included glucocorticoid + fludarabine in 1 case, HLH-94/04 protocols in 9 cases, and monotherapy corticosteroids in 1 case. Two patients died eventually. Perinatal HLH is commonly observed in the pregnancy/postpartum related HLH (28th week of pregnancy to one week after delivery) . Infection is still the commonest associated factors. HLH-94/04 protocols after the cessation of pregnancy may be effective, but the cessation of pregnancy itself may not be enough for the perinatal stage related-HLH. The perinatal stage related-HLH still has a better outcome than the other subtype of secondary-HLH.

摘要

分析围产期噬血细胞性淋巴组织细胞增生症(HLH)患者的临床特征。回顾性分析2011年1月至2016年10月期间收治的11例围产期HLH患者的产科资料、临床特征、相关疾病/因素及治疗转归。11例患者中初产妇9例。HLH发病时间:产前5例,产后6例。6例合并其他相关疾病/因素,其中感染最为常见(5/6)。治疗方法:1例采用糖皮质激素+氟达拉滨,9例采用HLH-94/04方案,1例采用单药糖皮质激素治疗。最终2例患者死亡。围产期HLH多见于妊娠/产后相关HLH(妊娠28周~产后1周),感染仍是最常见的相关因素。终止妊娠后采用HLH-94/04方案可能有效,但仅终止妊娠对围产期相关HLH可能不够。围产期相关HLH较其他继发性HLH亚型仍有较好的转归。

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