Reddy S C, Quah S H, Low H C, Jackson N
School of Medical Sciences, Universiti Sains Malaysia, Kelantan.
Ann Hematol. 1998 Jan;76(1):15-8. doi: 10.1007/s002770050354.
Retinal changes are common in adult acute leukemia patients at presentation, but their prognostic significance is controversial. A 5-year study has been carried out with newly diagnosed acute leukemia patients aged 12-77 years. Seventy-seven cases (49 AML, 28 ALL) were studied prospectively for the presence of intraretinal hemorrhages (IRH), white-centered hemorrhages, cotton-wool spots, and macular hemorrhages. They were treated according to standard chemotherapy protocols, and then achievement of complete remission (CR) and the duration of overall survival (OS) were compared between the groups with and without these different retinal features. No association was found between the presence of any retinal abnormality and CR induction rate, although there was a trend to a lower CR rate among patients with IRH. The median OS of those with IRH was 72 days, compared with 345 days among those without IRH (p=0.002). A WBC at presentation greater than 50x10(9)/l and age greater than 40 years were also associated with shorter OS (p<0.0001 and p=0.0045, respectively). However, after regression analysis, IRH remained statistically significant as a poor prognostic indicator (p=0.01). We conclude that the presence of IRH is an indicator of poor prognosis in acute leukemia.
视网膜病变在成年急性白血病患者初诊时很常见，但其预后意义存在争议。对12至77岁新诊断的急性白血病患者进行了一项为期5年的研究。前瞻性研究了77例患者（49例急性髓系白血病，28例急性淋巴细胞白血病）是否存在视网膜内出血（IRH）、中心白色出血、棉絮斑和黄斑出血。他们按照标准化疗方案进行治疗，然后比较有和没有这些不同视网膜特征的组之间完全缓解（CR）的实现情况和总生存期（OS）的持续时间。未发现任何视网膜异常与CR诱导率之间存在关联，尽管IRH患者的CR率有降低的趋势。有IRH患者的中位OS为72天，而无IRH患者为345天（p = 0.002）。初诊时白细胞计数大于50×10⁹/L和年龄大于40岁也与较短的OS相关（分别为p < 0.0001和p = 0.0045）。然而，经过回归分析，IRH作为不良预后指标仍具有统计学意义（p = 0.01）。我们得出结论，IRH的存在是急性白血病预后不良的一个指标。
