临床儿科杂志 ›› 2017, Vol. 35 ›› Issue (6): 458-.doi: 10.3969/j.issn.1000-3606.2017.06.015

• 综合报道 • 上一篇    下一篇

儿童卡梅现象13 例回顾性分析并文献复习

赵亚梅, 高怡瑾, 周莺, 马靖, 潘慈, 汤静燕   

  1. 上海交通大学医学院附属上海儿童医学中心血液肿瘤科(上海 200127)
  • 收稿日期:2017-06-15 出版日期:2017-06-15 发布日期:2017-06-15
  • 通讯作者: 高怡瑾 E-mail:gaoyijin@scmc.com.cn

Retrospective analysis in 13 children with Kasabach-Merritt phenomenon and review of literature

ZHAO Yamei, GAO Yijin, ZHOU Ying, MA Jing, PAN Ci, TANG Jingyan   

  1. Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Received:2017-06-15 Online:2017-06-15 Published:2017-06-15

摘要: 目的 讨论卡梅现象(KMP)的临床表现、诊断与治疗。方法 回顾分析2010年1月-2016年1月收治的13 例卡梅现象患儿的临床资料,并进行文献复习。 结果 13例患儿中男10例、女3例,发病年龄均<6个月。12例患儿有出血点、 瘀斑、黄疸和皮肤包块等皮肤表现, 1例表现为胸腔积液;病灶位置分布多样;血小板严重减少,纤维蛋白原减少,D-二聚 体升高;起病至确诊中位时间为60天。采用手术及糖皮质激素、心得安、干扰素、西罗莫司等药物治疗,10例缓解、 3例死 亡,其中6例给予西罗莫司治疗者疗效均满意。 结论 卡梅现象以血管肿瘤合并严重血小板减少及消耗性凝血异常为特 点,发病年龄小,起病至确诊时间较长;手术治疗疗效确切;西罗莫司或可成为卡梅现象的有效治疗手段。

Abstract:  Objective To improve understanding of the clinical manifestations, diagnosis and treatment of childhood Kasabach-Merritt phenomenon (KMP). Methods The clinical data of 13 patients admitted for KMP to XXX from January 2010 to January 2016 was retrospectively analyzed, with a review of relevant literature. Results The patients were 10 males and 3 females. The age of presentation varied from newborn to 5 months. 12 patients had cutaneous manifestations, like petechiae, ecchymosis, jaundice, skin masses, etc, 1 patient had pleural effusion. The location of lesions varied. The laboratory hallmark consists of profound thrombocytopenia and hypofibrinogenemia with elevated D-dimers. The median time from initial presentation to diagnosis was 60 days. After approaches like surgery, corticosteroids, propranolol, interferon, sirolimus, etc, 10 patients got remission while 3 patients died. 6 patients treated with sirolimushad complete response. Conclusions KMP is characterized with vascular tumor, severe thrombocytopenia and consumptive coagulopathy. Clinically, KMP often presents with early-onset and delay in diagnosis. Surgery is an effective approach for KMP. Sirolimus appears to be a promising treatment for KMP.