血液病合并结核患者由于细胞免疫缺陷,结核菌素试验常呈阴性反应.由于结核病症状缺乏特异性,痰涂片抗酸杆菌阳性率低,痰培养抗酸杆菌需4～8周才能得出结论,胸片改变也可不典型,给临床诊治带来了很大困难,甚至有些血液病患者在死后尸检时才发现活动性结核的存在.我们报道我院住院及会诊的血液病合并结核3例并作文献复习,对二者关系进行讨论.

OBJECTIVE To investigate the quantities of bone marrow CD5+ B lymphocytes in the patients with autoimmune hemocytopenia and the relationship between quantities of CD5+ B lymphocytes and clinical or laboratorial parameters. METHODS Quantities of CD5+ B lymphocytes in the bone marrow of 14 patients with autoimmune hemolytic anemia (AIHA) or Evans syndrome, 22 immunorelated pancytopenia (IRP) patients, and 10 normal controls were assayed by flow cytometry. The correlation between their clinical or laboratorial parameters and CD5+ B lymphocytes was analyzed. RESULTS The quantity of CD5+ B lymphocytes of AIHA/Evans syndrome (34.64% +/- 19.81%) or IRP patients (35.81% +/- 16.83%) was significantly higher than that of normal controls (12.00% +/- 1.97%, P < 0.05). However, there was no significant difference between AIHA/Evans syndrome and IRP patients (P > 0.05). In all hemocytopenic patients, the quantity of bone marrow CD5+ B lymphocytes showed significantly negative correlation with serum complement C3 level (r = -0.416, P < 0.05). In the patients with AIHA/Evans syndrome, the quantity of bone marrow CD5+ B lymphocytes showed significantly positive correlation with serum indirect bilirubin level (r = 1.00, P < 0.05). In Evans syndrome patients, the quantity of CD5+ B lymphocytes in bone marrow showed significantly positive correlation with platelet-associated immunoglobulin G (r = 0.761, P < 0.05) and platelet-associated immunoglobulin M ( r = 0.925, P < 0.05). The quantity of CD5+ B lymphocytes in bone marrow of all hemocytopenic patients showed significantly negative correlation with treatment response (tau-b = -0.289, P < 0.05) , but had no correlation with colony forming unit-erythroid (r = -0.205, P > 0.05) or colony forming unit-granulocyte-macrophage colonies (r = -0.214, P > 0.05). CONCLUSIONS The quantity of bone marrow CD5+ B lymphocytes in the patients with autoimmune hemocytopenia significantly increases and is correlated with disease severity and clinical response, which suggest that CD5+ B lymphocytes might play an important role in the pathogenesis of autoimmune hemocytopenia.

Objective To detect the quantities of monocyte-derived dendritic cell precursors (pDC1) and plasmacytoid dendritic cell precursors (pDC2) in peripheral blood mononuclear cells (PBMC) of severe aplastic anemia (SAA) patients before and after immune suppressive therapy (IST), the ratio of their pDC1 to pDC2, and the expression of T-cell co-stimulating molecules (CD80, CD86, CD40) on dentritic cells (DC) and B cells surface in the SAA patients' peripheral blood.

Objective To explore the mechanism of autoimmune intolerance in severe aplastic anemia (SAA). Methods By FACS, the quantity of peripheral TGF-βproducing CD4+ T cells (Th3) in 20 SAA patients at active phase, 10 SAA patients at recovery phase and 12 normal controls were detected. The percentages of peripheral CD4+ CD25+ regulatory T cells in 12 SAA patients at active phase, 9 non-responded patients after IST, 6 patients at recovery phase and 12 normal controls were counted, and its correlation with the percentages of CD3+ CD4+ and CD3+ CD8+ cells were analyzed. By enzyme linked immunosorbent assay (ELISA), the serum level of TGF-β1 in 25 SAA patients and 13 normal controls was measured and its correlation with peripheral platelets counts was analyzed. Results The percentages of peripheral Th3 cells, CD8+ TGF-β1+ cells and the ratio of Th3/ CD8+ TGF-β1+ in controls were (5. 10±0. 91)% , (4. 93±0. 97)% and 1.20±0. 19 respectively, and those in SAA patients at active phase were( 1. 33±0. 20)% , ( 1.72±0.24)%, 1.00±0.25, respectively (P0. 01 ,P0. 05). The aforementioned parameters of SAA patients at recovery phase increased to (2. 19±0. 21) % , (2. 07±0. 33) % and 1.71±0. 52 respectively, but the percentages of Th3 cells and CD8+ TGF-β1+ were still lower (P 0. 05 ). The percentage of Th3 cells was decreased in the SAA patients. The percentage of peripheral CD4+ CD25+ T regulator cells in peripheral blood of controls was (8. 25±1.96)% , and that in SAA patients was (3. 32±0. 81)%. The percentages of CD4+ CD25+ T cells of 9 non-responded patients and 10 patients at recovery phase were increased to (7.09±1. 84) % and (7.49±1. 27) % respectively, being no difference from those of normal controls. The percentage of CD4+ CD25+ T cells of SAA patients was positively related to the percentage of CD3+ CD4+ cells and the ratio of CD3+ CD4+ to CD3+ CD8+ , but negatively to the percentage of CD3+ CD8+ cells. The percentage of CD4+ CD25+ T cells was decreased in the SAA patients. The plasma level of TGF-β1 in normal controls was (11.06±0.49)μg/L, and that in SAA patients was (2. 49±0. 51)μg/L (P 0. 01). The plasma level of TGF-β1 in SAA patients was positively related to the percentage of Th3 cells and the platelet counts (P 0. 05, P 0.01). Conclusion The percentages of peripheral Th3 and CD4+ CD25+ T cells, and the plasma level of TGF-β1 in SAA patients were decreased, which break down the autoimmune tolerance in SAA.

儿科学是一门研究小儿生长发育规律,提高儿童保健质量及疾病诊治水平,全方位为儿童健康服务的医学科学。儿科学教学是在讲授人体发育的过程中,阐述疾病的发生发展过程,使群体和个体、整体和局部、身体与心理等各方面内容在儿科学教学过程中得到有机地结合和贯彻。儿科学教育工作者肩负着不断更新知识结构,探索适应社会需求的教学方法和途径的艰巨任务。整体儿科学教学的结构和内容, 将随着社会的发展和需要作相应的调整。儿科学教育对学生沟通交流能力的培养,也变得越来越重要。

OBJECTIVE:To analyse the proportion of hepatitis associated aplastic anemia (HAAA) in severe aplastic anemia (SAA) and its clinical features of HAAA.METHODS:All newly diagnosed SAA cases in our department in the recent 5 years were analyzed. A case-control study was undertaken to investigate the differences of clinical and laboratory features between HAAA and non-hepatitis associated SAA (non-HASAA) patients.RESULTS:The proportion of HAAA in SAA was 3.3%. There was no significant difference in PB cell counts, bone marrow hematopoiesis status and the amount of blood transfusion between HAAA and non-HASAA patients. Sera from 13 patients with HAAA were tested for antibodies to hepatitis viruses A, B, and C and hepatitis B surface antigen. Twelve (92.3%) of them had negative serologic results for the tests and only one (7.7%) had a positive result for HBsAg and HBeAg. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were decreased prior to the diagnosis in twelve (92.3%) of the 13 HAAA patients. The percentage of CD4(+) cells in HAAA patients was significantly lower than that in non-HASAA patients (P < 0.05). HAAA patients had higher percentages of CD8(+) cells (P < 0.05) and lower ratios of CD4(+)/CD8(+) (P < 0.05). The early infection rate of the HAAA patients was significantly higher than that of non-HASAA patients (84.6% vs 42.3%, P < 0.05), with different mortalities (61.5% vs 15.4%, P < 0.05). The 2-year survival rate of HAAA patients was significantly lower than that of non-HASAA patients (16.6% vs 83.2%, P < 0.01).CONCLUSION:The proportion of HAAA in SAA was 3.3%. Most of HAAA were associated with non-A, non-B and non-C hepatitis virus. Compared with that of non-HASAA, the abnormality of T cell immunity of HAAA was more severe, with a higher frequency of early infection and a higher mortality rate.

目的探讨自身免疫性血细胞减少症患者骨髓CD+5B细胞数量及其临床意义.方法 2001-03～2002-04对中国医学科学院血液病医院的住院患者14例检测自身免疫性溶血性贫血(AIHA)和Evans综合征和22例免疫相关性全血细胞减少症(IRP)及10名正常对照骨髓CD+5B细胞数量并与临床及实验室指标做相关分析.结果 AIHA、Evans综合征和IRP患者CD+5B细胞数量[(34.64±9.81)%,(35.81±16.83)%]高于正常人[(12.0±1.97)%],(P<0.05),CD+5B细胞的数量与补体C3呈负相关(P<0.05),与间接胆红素呈正相关(P<0.05);与Evans综合征患者血小板抗体PAIgG(P<0.05)、PAIgM(P<0.05)呈正相关;与临床疗效呈负相关(P<0.05).结论 CD+5B细胞在自身免疫性血细胞减少症的发病机制中可能具有重要意义.

Background A subpopulation of B lymphocytes expressing CD5 antigen is involved in several autoimmune diseases through the release of autoantibodies. We investigate the quantitative of CD5 + B lymphocytes in the bone marrow of the patients with autoimmunic hemocytopenia and study the relationship between quantity of CD5 + B cells and clinical or laboratorial parameters of these patients.Methods Quantities of CD5 + B lymphocytes in the bone marrow(BM)of 14 patients with autoimmune hemolytic anemia(AIHA) or Evans syndrome, 22 immunorelated pancytopenia (IRP) patients and 10 normal controls were assayed by FACS. The correlation between their clinical or laboratory parameters and CD5 + B lymphocytes was analyzed. Results The qutantity of CD5 + B lymphocytes of AIHA/Evans syndrome ((34.64±19.81)% or IRP((35.81±16.83)%) patients was significantly higher than that of normal controls((12.0±1.97)%)(p 0.05). The quantity of CD5 + B lymphocytes in the bone marrow of all cytopenic patients showed negative correlation with complement C 3 (r=−0.416, p + B lymphocytes showed positive correlation with indirect bilirubin(IBIL) (r=1.00, p + B lymphocytes in their bone marrow showed positive correlation with PAIgG (r=0.761, p + B lymphocytes in the bone marrow of all cytopenic patients showed negative correlation with treatment response (correlation coefficient tau-b=−0.289, p in vitro . Conclusion BM CD5 + B lymphocytes of the patients with autoimmunic hemocytopenias significantly increased and was related to the disease severity and clinical response. It was suggested that CD5 + B lymphocytes might play an important role in the pathogenesis of autoimmunic hemocytopenia.

OBJECTIVE:To study the quantity and ratio of Th1, Th2 cells in the bone marrow of myelodysplastic syndromes (MDS) patients, and to evaluate the correlation between the ratio of the blast cells and the number of the Th1 cells in the bone marrow of MDS patients.METHODS:By FACS, the quantity and ratio of IFN-gamma producing CD4(+) T cell (Th1) and IL-4 producing CD4(+) T cell (Th2) cells in the bone marrow were detected in 21 MDS patients, 18 normal controls and 13 severe aplastic anemia (SAA) patients respectively. The karyotypes of 18 MDS patients and 15 normal controls were assayed. The correlation between the ratio of the blast cells in the bone marrow and the number of the Th1 cells in the MDS patients were analyzed.RESULTS:The percentages of Th1 cells, Th2 cells and ratio of Th1/Th2 in the bone marrow of normal controls were (0.48 +/- 0.10)%, (0.24 +/- 0.19)% and 2.31 +/- 0.76 respectively, while those of the MDS patients were (0.36 +/- 0.11)%, (0.76 +/- 0.35)% and 0.51 +/- 0.13. The percentage of Th1 cells of patients with MDS was reduced and the Th1/Th2 ratio was significantly lower than that of normal controls (P < 0.01). Those of the patients with SAA were (4.75 +/- 0.49)%, (0.40 +/- 0.28)% and 26.5 +/- 8.79 respectively, their Th1 cells and Th1/Th2 ratio were markedly higher than those of normal controls (P < 0.01). In all of the 15 normal controls the karyotypes were normal, but that of MDS patients was (50.00 +/- 0.10)%. The lower ratio of the Th1 cells in the bone marrow of the patients with MDS and the AML which progressed from MDS was negatively correlated with the higher percentage of the blast cells (r = -0.563, P < 0.01).CONCLUSIONS:(1) The immune function of T lymphocytes in MDS is abnormal: the balance between Th1 and Th2 cells is broken. (2) With descending of the number of Th1 cells in the bone marrow of the MDS patients, the disease is progressing to leukemia.

Aim: To observe the effects of iron-deprivation on the expression of multidrug resistance gene1(MDR1)and activation of NF-κB K562 cells induced by daunorubicin(DNR). Methods: RT-PCR and flow cytometry assay were used respectively to detect the expression of MDR1 mRNA and P glyloprotein(Pgp) after K562 cells receiving the treatment of 25 μmol/L iron chelator-desferioxamine (DFO) only or added with 1.0 μmol/L DNR.The DNA-binding activation of NF-κB was detected by using electrophoretic mobility shift assay (EMSA). K562 cells without any treatment served as control.Results: Compared with the control group,the expressions of MDR1, Pgp and the activation in NF-κB in K562 cells could be induce by DNR(P0.05). When K562 cells were cultured with 25 μmol/L DFO for 24 h,the expressions of MDR1, Pgp and the activation of NF-κB induced by DNR were significantly suppressed(P0.05). Conclusion: Iron-deprivation could decrease the expressions of MDR1 and Pgp and the activation of NF-κB in K562 cells induced by DNR,the mechanism may be related to suppressing the activation of NF-κB.

OBJECTIVE To study the apoptosis and proliferation of CD(34) positive (CD(34)(+)) bone marrow cells (BMC) in patients with polycythemia vera (PV). METHODS The expression of Annexin V and Ki67 of the CD(34)(+) BMC in 20 PV patients and control cases [10 essential thrombocythemia (ET), 12 normal persons] were assessed by bicolor flow cytometry (FCM), and the correlation between apoptosis and clinical situation was analysed in PV patients. RESULTS The Annexin V expressions of CD(34)(+) BMC were (15.96 +/- 1.45)% in PV patients and (15.53 +/- 1.76)% in ET patients which were lower than that in normal subjects [(23.61 +/- 3.89)%, (P < 0.05)]. The Ki67 expression of CD(34)(+) BMC was (48.79 +/- 11.68)% in PV patients and (49.60 +/- 9.98)% in ET patients, which were significantly higher than that in normal controls (33.87 +/- 6.82)%. The ratio of apoptosis/proliferation in PV patients was 0.33 +/- 0.10 and in ET patients 0.32 +/- 0.02 which were significantly lower than that in normal controls 0.72 +/- 0.11 (P < 0.01). The apoptosis of CD(34)(+) BMC was negatively correlated with the hemoglobin (Hb) levels (r = -0.481, P = 0.037), white blood cells (WBC) (r = -0.538, P = 0.026) and the numbers of endogenous erythroid colony (EEC) (r = -0.632, P = 0.50), and the ratio of apoptosis/proliferation was negatively correlated with the Hb (r = -0.537, P = 0.018) and WBC (r = -0.667, P = 0.003) in PV patients. CONCLUSION There were lower apoptosis and higher proliferation in CD(34)(+) BMC of PV patients. Lower apoptosis was correlated with the severity of the disease.

目的:探讨骨髓转移瘤与浆细胞性骨髓瘤(PCM)的诊断与鉴别诊断要点.方法:对1例骨髓转移性低分化腺癌的骨髓涂片作Wright's染色及PAS染色,骨髓活检(BMB)作塑料包埋H-Giemsa-E染色和嗜银染色.结果:患者,男,63岁,表现严重的腰腿痛,多发性骨质破坏,既往曾有结肠癌手术史.骨髓涂片可见98.5%胞体较大,胞质丰富,核仁大的瘤细胞呈散在或小簇分布,红细胞呈缗钱状,血清IgA升高,初诊为PCM,但BMB示瘤细胞呈巢状排列,胞质丰富,有空泡.瘤细胞间无网状纤维,癌巢有网状纤维环绕.最后诊断为"骨髓转移性低分化腺癌".对二者的发病年龄、症状与体征、骨髓细胞学、骨髓组织学以及影像学,血、尿免疫球蛋白定性与定量,瘤细胞免疫表型及IgH基因PCR检测的特点等作了鉴别.结论:BMB是诊断骨髓转移瘤和浆细胞性骨髓瘤的金标准.

目的:探讨Shwachman-Diamond综合征的临床及病理变化的特点.方法:对1例该病患者进行了血象、骨髓涂片、组化染色、染色体、骨髓切片和肝肾功能以及骨骼X线的检查.结果:患者由再障转为白血病,突出发现骨骼病变为全身骨质疏松.结论:Shwachman-Diamond综合征甚为罕见,此综合征以胰腺功能不全、白细胞减少、干骺端发育障碍为主要的3种病变。

目的了解联合化疗治疗高危组骨髓增生异常综合征(MDS)及其转化的急性髓系细胞白血病(post MDS-AML)的疗效和影响因素.方法 24例高危组MDS和23例post MDS-AML患者接受联合化疗方案化疗(DA方案31例,HA方案13,IA方案3例),联合化疗加用造血生长因子17例,单用联合化疗30例.采用2000年MDS国际工作组疗效评定新标准评价47例患者的联合化疗疗效,并评估MDS国际预后积分系统(IPSS)的临床意义.结果 14例(29.8%)患者获得完全缓解(CR),部分缓解(PR)10例(21.3%),稳定状态(SC)2例(4.3%),失败(failure)21例(44.7%),总有效率51.1%.高龄组(年龄超过50岁)的CR率(53.8%)明显高于年龄小于50岁的低龄组(20.6%,P=0.037).IPSS积分系统中染色体核型分组(Good组,Intermediate组和Poor组)的CR率分别为76.9%,23.5%,0%(P<0.01),3组间的总有效率(76.9%,64.7%和11.1%),失败率(23.1%,29.4%,77.8%)均有统计学差异.姐妹染色体分染(SCD)阴性组的CR率(26.3%)显著低于阳性组的CR率(71.4%,P=0.036),且阴性组的总有效率(52.6%)也低于阳性组(100%,P=0.024).DA方案的CR率(38.7%)和总有效率(61.3%)明显高于HA方案CR率(7.7%,P=0.04)和总有效率(23.1%,P=0.021),并且DA方案的失败率(32.3%)显著低于HA方案的失败率(76.9%,P=0.007).结论高危组MDS及post MDS-AML是一组难治性疾病,约51%的患者可从联合化疗中获益.染色体核型异常和姐妹染色体分染对化疗疗效有预后意义.

OBJECTIVE:To evaluate the quantitative and functional changes of T helper (Th) cell subsets in the bone marrow of severe aplastic anemia (SAA) patients and the relationship between these changes and the patients hematopoietic function. METHODS:By FACS, the quantity and ratio of Th1 and Th2 cells, the percentage of CD3(+)CD8(+) cells in the bone marrow were detected in 24 patients with SAA at active phase, 15 patients with SAA at recovery phase, and 16 normal controls. By radioimmunoassay, the serum levels of TNF-alpha, or IL-4 in 20 SAA patients at active phase, 12 at recovery phase and 16 normal controls were measured. The relationships between CD3(+)CD8(+) cells, TNF-alpha and Ret, ANC; and between Th1 cells and CD3(+)CD8(+) cells, TNF-alpha or Ret, ANC; between IL-4, balance of Th1/Th2 and Ret, ANC were evaluated. RESULTS:The percentages of Th1 and Th2 cells, and ratio of Th1/Th2 in bone marrow of SAA patients at active phase were (4.87 +/- 2.64)%, (0.41 +/- 0.26)% and 21.22 +/- 5.07, respectively, being higher than those of normal controls [(0.42 +/- 0.30)% (P < 0.01), (0.24 +/- 0.17)% (P < 0.05) and (1.57 +/- 0.93) (P < 0.01), respectively] and all of them reduced to normal levels of SAA at recovery phase (P > 0.05). The percentage of CD3(+)CD8(+) cells significantly decreased from (32.32 +/- 8.69)% at active phase to (13.76 +/- 2.96)% at recovery phase (P < 0.01). The serum levels of TNF-alpha and IL-4 at active phase was (4.29 +/- 3.15) microg/L and (1.24 +/- 0.73) microg/L, respectively, being higher than those of normal controls (1.21 +/- 1.16) microg/L, (1.18 +/- 0.97) microg/L, but only the difference of TNF-alpha was statistically significant (P < 0.01). In recovery SAA patients, the serum levels of TNF-alpha significantly decreased to (1.46 +/- 1.41) microg/L (P < 0.01), and the levels of IL-4 increased markedly to (3.05 +/- 1.94) microg/L. The CD3(+)CD8(+) cells and TNF-alpha of patients negatively correlated with Ret (P < 0.05; P < 0.05) and ANC (P < 0.05; P < 0.05), Th1 cells correlated with CD3(+)CD8(+) cells and TNF-alpha positively (P < 0.01; P < 0.05), the Ret and ANC negatively (P < 0.01; P < 0.01), IL-4 and the balance of Th1/Th2 positively correlated with Ret and ANC (P < 0.05, P < 0.01; P < 0.01, P < 0.01). CONCLUSION:The bone marrow failure in SAA might be caused not only by the increase of Th1 cells, Th1 type effector cells and cytokines, but also by insufficient compensation of Th2 cells and Th2 type cytokines, which shifted the balance of Th1/Th2 favorable to Th1.

BACKGROUND:Polycythemia vera (PV) is a malignant disorder of hemaopoietic stem cells which is characterized by clonal hyperproliferation and a low rate of apoptosis. This study was to assess endogenous erythroid colony (EEC) formation in the bone marrow of PV patients and determine its clinical significance.METHODS:The bone marrow mononuclear cells of 26 patients with PV, 2 patients with secondary erythrocytosis (SE), and 19 normal controls were cultured by Marsh's method for EEC evaluation, and the clinical significance was evaluated.RESULTS:EECs appeared in 25 patients with PV but not in 2 patients with SE and 19 normal controls. The number of EECs and the EEC ratio [EEC/erythropoietin (EPO)-dependent colony forming unit-erythroid (CFU-E)] in PV patients positively correlated with hemoglobin (Hb) levels. Their EEC number did not correlate with white blood cell (WBC) counts, platelet (PLT) counts, or leukocyte alkaline phosphatase (LAP) scores. Their EEC did not correlate with serum EPO levels. Fifteen patients with PV were treated with hydroxyurea (Hu) and/or interferon-alpha (IFN-alpha). Their EEC ratio before treatment positively correlated with the treatment time required for complete remission (CR) and negatively correlated with the time before relapse. The EEC numbers of 7 PV patients treated with Hu/IFN-alpha decreased after the blood cell counts dropped to normal levels. There was a positive correlation between the EEC ratio and the incidence of attacks of vascular thrombosis in PV patients. The numbers of apoptosised bone marrow mononuclear cells in PV patients were lower than those in normal controls. The EEC numbers of PV patients negatively correlated with the rate of apoptosis of bone marrow mononuclear cells.CONCLUSIONS:EEC formation is characteristic in PV patients. EEC number in PV patients positively correlates with Hb levels, the time required for CR, and the incidence of attacks of vascular thrombosis. EEC number negatively correlates with the time before relapse. Bone marrow suppressive treatment might decrease EEC number. Thus, EEC number is a sensitive and specific parameter reflecting the abnormal hematopoietic clone burden induced by polycythemia vera. EEC number is an important diagnostic parameter for PV patients.

编者按 急性髓系白血病M2b是中国医学科学院血液学研究所(下简称血研所)于1959年发现的一种特殊粒细胞型白血病.血研所不仅早于国外学者发现M2b,而且在很长时间里,经过几代血液学专家的努力,对M2b的临床特点、治疗方法、免疫学表型、细胞遗传学和分子生物学等均有了深入的认识和研究.本期发表的由杨崇礼教授等撰写的"急性髓系白血病M2b的研究进展"是一篇内容丰富的佳作,体现了我国学者对M2b研究的辉煌成果.本文不仅反映了我国研究的成绩,而且介绍了当今国际上对M2b的诸多认识,对M2b的方方面面进行了阐述,这些足令读者对M2b能有全面的了解.

自身免疫性溶血性贫血(AIHA)和Evans综合征复发率高,长期缓解率只有13%～16%[1,2].复发后如何再治疗是临床上一大难题.我们对我院收治的AIHA/Evans综合征复发患者30例进行再治疗观察,了解再治疗疗效,并分析不同治疗方案对再治疗疗效的影响.现将结果报告如下.

目的观察CODPL方案治疗小儿急性淋巴细胞白血病(ALL)的临床疗效. 方法 1990～1998年对60例ALL儿童使用CODPL诱导方案治疗,观察其临床疗效.结果 59例获得完全缓解,缓解率为98.3%,中位随访时间48月,5年预期无病生存率(DFS)为71%,高危ALL为74%,标危ALL为69%,两组生存率曲线差异无显著性(P>0.05).结论强烈化疗可使患儿病情获得缓解,重视再诱导巩固治疗对提高ALL长期存活率具有重要意义.