Myers T J, Cole S R, Klatsky A U, Hild D H
Cancer. 1983 May 15;51(10):1808-13. doi: 10.1002/1097-0142(19830515)51:10<1808::aid-cncr2820511009>3.0.co;2-y.
Four patients with acute nonlymphocytic leukemia and leukocyte counts of more than 200,000/mm3 developed respiratory distress due to pulmonary leukostasis within 10-48 hours after initiation of chemotherapy. Clinically, the patients manifested fever, dyspnea, tachypnea, diffuse pulmonary rales, pleural effusions, and severe hypoxemia. Chest roentgenograms displayed diffuse pulmonary infiltrates, vascular engorgement, cardiomegaly, and pleural effusions. Three patients died from progressive respiratory failure despite ventilatory support. Pulmonary histology revealed thrombi composed of leukemic blast cells which obstructed and distended the lumens of pulmonary arterioles, capillaries, and venules. Electron microscopy studies of lung tissue showed pulmonary alveolar endothelium and basement membrane damage and interstitial edema. The pathophysiologic basis of pulmonary leukostasis and potential treatment modalities are discussed.
4例急性非淋巴细胞白血病患者，白细胞计数超过200,000/mm3，在化疗开始后10 - 48小时内因肺白细胞淤滞而出现呼吸窘迫。临床上，患者表现为发热、呼吸困难、呼吸急促、双肺弥漫性啰音、胸腔积液和严重低氧血症。胸部X线片显示双肺弥漫性浸润、血管充血、心脏扩大和胸腔积液。尽管给予通气支持，3例患者仍死于进行性呼吸衰竭。肺组织学检查发现由白血病原始细胞组成的血栓，阻塞并扩张了肺小动脉、毛细血管和小静脉的管腔。肺组织的电子显微镜研究显示肺泡内皮和基底膜损伤以及间质水肿。本文讨论了肺白细胞淤滞的病理生理基础和潜在的治疗方式。
