患儿在诊断时即出现 4 级非常严重的高三酰甘油血症，该患儿患有急性淋巴细胞白血病。
Grade 4 very severe hypertriglyceridaemia at diagnosis in a child with acute lymphoblastic leukaemia.
机构信息
Pediatrics, Army Hospital Research and Referral, New Delhi, India
Pathology, Army Hospital Research and Referral, New Delhi, India.
出版信息
BMJ Case Rep. 2022 Jul 11;15(7):e245820. doi: 10.1136/bcr-2021-245820.
Dyslipidaemia is seen in nearly all cases of acute lymphoblastic leukaemia (ALL) at diagnosis, with mild hypertriglyceridaemia (HTG) in 61% and reduced high-density lipoprotein in 98% cases. HTG irrespective of severity is due to metabolic derangements associated with tumour cells turnover in haematological malignancies and is generally self-limiting. Very severe HTG with overt lipaemic serum is extremely rare at presentation in ALL. HTG is complicated by thrombosis, osteonecrosis and pancreatitis during induction chemotherapy for ALL with steroids and L-asparginase. A careful monitoring is required during induction chemotherapy in ALL when severe HTG is present at diagnosis. We present a female toddler with ALL, who presented with very severe HTG and grossly lipaemic serum. Her very severe HTG decreased to mildly raised HTG at the end of first week of induction chemotherapy. There was no further complication noticed during induction therapy.
在诊断时，几乎所有急性淋巴细胞白血病（ALL）病例都存在血脂异常，其中 61%存在轻度高甘油三酯血症（HTG），98%存在高密度脂蛋白降低。无论严重程度如何，HTG 都是由于血液恶性肿瘤中与肿瘤细胞更替相关的代谢紊乱引起的，通常是自限性的。在 ALL 中，初诊时非常严重的 HTG 并伴有明显的脂血症血清极为罕见。在 ALL 用类固醇和 L-门冬酰胺酶进行诱导化疗期间，严重的 HTG 会导致血栓形成、骨坏死和胰腺炎。当在诱导化疗时存在严重的 HTG 时，需要进行仔细监测。我们报告了一例 ALL 女性幼儿病例，该患者存在非常严重的 HTG 和明显的脂血症血清。她非常严重的 HTG 在诱导化疗第一周末降至轻度升高的 HTG。在诱导治疗期间没有发现其他并发症。
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