Clinical Characteristics Study Of Acute Leukemia With Bone And Joint Pain As The First Manifestation

Objective: Through comparative analysis of the clinical data of children with acute leukemia with bone and joint pain as the first manifestation and children with orthopedic diseases with bone and joint pain as the main manifestation,the characteristics of clinical manifestations and differences were summarized,and the influencing factors of children with bone and joint pain as the first manifestation were screened for the diagnosis of acute leukemia.To explore how to distinguish early acute leukemia with bone and joint pain as the first manifestation and common bone and joint pain diseases in bone and joint pain department,so as to improve the early diagnosis rate of acute leukemia and reduce the rate of missed diagnosis and misdiagnosis,so that children with acute leukemia can get early and timely correct treatment,and improve their survival rate and cure rate.Methods: The clinical data of children with acute leukemia(AL group)who were misdiagnosed as other diseases during January 2015 to October 2020 in our hospital(90 cases)were retrospectively analyzed,as well as the clinical data of children with orthopedic diseases(control group)who were mainly manifested as osteoarthropathy during the same period(85 cases).The differences in general conditions,symptoms and signs,and the earliest traceable blood routine results between the two groups were compared.The indicators with statistically significant differences between the two groups of clinical data were taken as independent variables,and the final diagnosis of acute leukemia was taken as dependent variable.The independent influencing factors were obtained by binary Logistic regression analysis,and the risk prediction model equation was established,and then the ROC curve was drawn to verify the accuracy of the equation.Result:Among the 90 children in AL group,17(18.9%)were diagnosed as general infection(muscle and soft tissue infection),6(6.7%)as suppurative hip and knee arthritis,9(10.0%)as acute osteomyelitis,5(5.6%)as growing pain,23(25.6%)as simple synovitis of hip and knee,and 23(25.6%)as simple synovitis.Arthritis(rheumatoid,reactivity,juvenile idiopathic)19 cases(21.1%),other misdiagnosis diagnosis(soft tissue injury,type of polio syndrome,cerebellar ataxia,bone metabolic disease,neuropathy,multiple sclerosis,multiple myositis,Langerhans cell tissue hyperplasia,femoral head necrosis)in 11 cases(12.2%),Among them,43 cases(47.8%)were misdiagnosed as orthopedic diseases.Binary Logistic regression analysis showed that age < 7 years old(P =0.041,B=1.567,OR=4.791,95%CI: 1.59-14.43),fever(P < 0.01,B=1.478,OR=4.386,95%CI: 1.41-13.60),multisite pain(P < 0.01,B=3.272,OR=26.352,95%CI: 7.97-87.14),decreased Hb(P < 0.01,B=2.232,OR=9.314,95%CI: 3.23-16.87),PLT decreased(P < 0.01,B=4.705,OR=110.502,95%CI: 9.55-1278.66).The corresponding area under the ROC curve was 0.941,P < 0.01,95%CI(0.909,0.973),with high accuracy.The critical prediction probability was 0.6646,the sensitivity was 0.822,and the specificity was 0.906.In this study,the prediction accuracy of the risk prediction model established based on the analysis results was 83.33% when it needed to predict the diagnosis of AL,and 89.41% when it needed to predict the diagnosis of orthopedic disease.Conclusion: 1.Children with AL with joint pain as their first manifestation are prone to be misdiagnosed,especially as orthopedic diseases;2.In the children with bone and joint pain as the first manifestation,the influencing factors for the diagnosis of leukemia were: age < 7 years old,multi-site pain,fever,reduced Hb and PLT;3.For children with bone and joint pain as the first manifestation,the risk equation for predicting acute leukemia was: LN(P /1-P)=4.705*PLT count reduction +2.232* Hb level reduction +1.478*fever +3.272* multi-site pain +1.567* age < 7 years-4.043.