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发表于 2016-11-18 13:44:44
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来自： 中国北京
如果怀疑中枢神经系统侵犯，但是没有影像学和脑脊液细胞学的证据，那么用脑脊液做流式细胞术可能有所帮助，因为这是一个灵敏度很高的检查。也存在并没有发生中枢神经系统侵犯的可能性，有关症状是化疗药物毒性引起的，原因是：首先，AITL不是一个非常容易发生中枢神经系统侵犯的疾病，在外周T当中其侵袭性算是比较低的；其次，根据你的描述也做了鞘注预防，应该能够进一步减小了发生侵犯的几率；第三，hyperCVAD方案的B方案是甲氨喋呤和阿糖胞苷，这两种药是都具有潜在的中枢神经系统毒性的，例如，下面这段话来自于某教科书中对阿糖胞苷中枢神经系统毒性的描述：
These changes, however, are generally clinically unimportant and reversible. A more dangerous toxicity involving cerebral and cerebellar dysfunction occurs in 10% of patients receiving 3 g/ m2 for 6 doses and in two thirds of patients receiving 4.5 g/ m2 for 12 doses.
Age over 40 years, abnormal alkaline phosphatase activity are risk factors associated with an increased susceptibility to CNS toxicity, which is manifested as slurred speech, unsteady gait, dementia, and coma. Thirty-seven percent of patients with two or more of these risk factors treated with high-dose ara-C develop CNS toxicity in 37% of the cases, whereas the incidence is less than 1% when fewer than two of these criteria are present.
Symptoms of neurologic toxicity resolve within several days in approximately 20% of patients and gradually recede over several weeks in approximately 40%; however, a permanent disability is present in the remaining 40%, and occasionally patients have died of CNS toxicity.
里面说阿糖胞苷的CNS毒性表现为吐字不清，步态不稳，迟钝和昏迷，有20%人几天后症状就会缓解，40%的人几周后可以缓解。所以，观察一下如果相关症状逐渐减轻的话应该考虑不是中枢神经系统侵犯，但如果持续加重的话那么CNS侵犯就可能性很大了
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楼主: 明若晓溪
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发表于 2016-11-18 22:22:17
，我要崩溃了
