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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
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  • 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

  网络出版日期: 2017-06-15

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
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  • Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China

Received date: 2017-06-15

  Online 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。

本文引用格式

赵亚梅 ,  高怡瑾 ,  周莺 ,  马靖 ,  潘慈 ,  汤静燕 . 儿童卡梅现象13 例回顾性分析并文献复习[J]. 临床儿科杂志, 2017 , 35(6) : 458 . DOI: 10.3969/j.issn.1000-3606.2017.06.015

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.
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