郑州11岁女孩双眼变绿，两天确诊肝衰竭！孩子这种情况千万别忽视

仅供医学专业人士阅读参考

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11岁女孩肝衰竭治疗中意外查出白血病，转氨酶高出正常85倍，双眼从黄变绿——“肝衰竭+白血病”这对致命组合，究竟是如何发生的？

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portant;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__7"> portant;overflow-wrap:="" break-word="" !important;"="">整理：易艾蓝

从头痛到全身发黄，只有两天

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__13">2026年3月，河南郑州11岁女孩妮妮因头痛、肚子疼被妈妈带到当地诊所。服药仅两天后，妈妈惊恐地发现：孩子的全身皮肤开始发黄，连眼珠也染上了黄色——这是黄疸的典型表现，意味着肝脏功能已严重受损。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__17">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__19">医院检查结果令人震惊：重度肝衰竭。妮妮的转氨酶高出正常值85倍，胆红素急剧飙升。妈妈回忆道：“刚开始眼睛发黄，现在已经全变绿了。”

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__24">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__26">然而，更残酷的打击接踵而至。就在全力治疗肝衰竭的过程中，进一步检查又查出了急性白血病。两种致命重病，同时压在了这个11岁孩子的身上。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__29">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__31">由于病情危重，妮妮需要在清明返程高峰期间从郑州紧急转往北京儿童医院。一条“看见豫AVF120请让行”的倡议在网络上传开，牵动了无数人的心。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__34">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__36">那双从黄变绿的眼睛，成了这个孩子身体发出的最极致的求救信号。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__38">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" center;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__40">来源：微博热搜

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临床警示：肝衰竭可能是白血病的“首发伪装”

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__49">要理解妮妮的病情，首先得明白“变绿”意味着什么。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__52">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__54">正常情况下，红细胞衰老分解产生的胆红素，由肝脏处理后经胆汁排出体外。当肝脏严重衰竭时，大量胆红素滞留在血液中，沉积在皮肤和巩膜（眼白）上，呈现黄色。而一旦结合胆红素浓度超过85μmol/L，它会与肠道细菌代谢产物结合，使皮肤和眼白呈现出黄绿色——这就是“双眼变绿”的病理本质。这标志着肝脏的解毒、排泄功能已接近完全丧失，是危急时刻的警示信号。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__57">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__59"> 肝衰竭与白血病之间又是什么关系？急性白血病以肝衰竭为首发表现，在临床上极为罕见。一份发表于《Journal of Medical Evidence》的病例报告明确指出。这种情况“几乎从未被纳入肝功能异常的鉴别诊断中”^[1]。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__65">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__67">但罕见不等于不会发生。白血病主要通过两条路径攻击肝脏：

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;letter-spacing:="" 0.544px;background-color:="" rgb(255,="" 255,="" 255);"="" class="js_darkmode__69">

• inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__72">白血病细胞直接浸润肝脏。恶性淋巴细胞不仅侵犯骨髓，还会随血液循环扩散到肝、脾等髓外器官。它们在肝窦内大量聚集，直接挤压正常肝细胞，干扰微循环，导致肝细胞缺血坏死。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__74">

• inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__75">继发性因素进一步加重肝损伤。白血病导致骨髓造血功能衰竭，容易继发严重感染；同时，肿瘤细胞释放大量细胞因子（如IL-6、TNF-α），引发过度炎症反应，甚至诱发噬血细胞性淋巴组织细胞增生症（HLH）。一项发表于《Frontiers in Pediatrics》的病例报告曾报道，白血病患儿因感染水痘后并发HLH，导致暴发性肝衰竭^[2]。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__84">尤其值得每一位临床医生警惕的是：肝衰竭可能是白血病的首发表现，且早期可以完全没有血液系统异常。2025年的一份病例报告描述了一名9岁男孩，以黄疸、显著肝酶升高（ALT 1283 U/L、AST 1325 U/L）起病，最终确诊为B-ALL，此前没有任何血液系统异常^[3]。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__92">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__94">这意味着，对于临床上原因不明的儿童急性肝衰竭，尤其是伴有发热、贫血、血小板减少、淋巴结肿大或不明原因肝脾肿大的患儿，必须将血液系统恶性疾病纳入鉴别诊断。国内专家共识也明确指出：儿童肝衰竭中，肿瘤相关性肝衰竭预后差、病死率高，延迟诊断将导致严重后果^[4]。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;letter-spacing:="" 0.544px;background-color:="" rgb(255,="" 255,="" 255);"="" class="js_darkmode__100">

治疗困境：先救肝还是先治白血病？

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__106">这似乎是一个两难选择：白血病若不及时治疗，疾病本身会继续摧毁肝脏；但肝衰竭状态下使用化疗药物，又面临严重毒性风险。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__108">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__110">然而，答案并非只能是“两害相权取其轻”。2025年的一份病例报告给出了重要启示^[3]：一名9岁B-ALL合并严重肝功能障碍的患儿，接受了未经减量的标准诱导化疗——结果肝功能在29天内迅速恢复正常，微小残留病仅0.001%，且未观察到并发症。该报告指出：“白血病浸润被明确为肝炎的病因，早期诊断、多学科管理和密切监测至关重要。”

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__116">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__118">这个案例提示：当肝损伤的根源是白血病细胞浸润时，控制原发病本身就是保肝治疗。关键在于精准鉴别肝衰竭的病因，而非机械地将肝功能异常视为化疗的绝对禁忌。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;letter-spacing:="" 0.544px;background-color:="" rgb(255,="" 255,="" 255);"="" class="js_darkmode__121">

写在最后

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__128">妮妮的故事，既是一个家庭的悲剧，也是一次对临床医生的深刻提醒：儿童急性肝衰竭的鉴别诊断清单里，绝不能遗漏血液系统恶性疾病。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__130">

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__132">那双从黄变绿的眼睛，承载的不仅是胆红素的数值，更是一个孩子顽强的生命意志，和一整个家庭的希望。

inkmacsystemfont,="" "helvetica="" neue",="" "hiragino="" sans="" gb",="" "microsoft="" yahei="" ui",="" "microsoft="" yahei",="" arial,="" sans-serif;font-size:="" 17px;font-style:="" normal;font-variant-ligatures:="" normal;font-variant-caps:="" normal;font-weight:="" 400;letter-spacing:="" 0.544px;orphans:="" 2;text-align:="" justify;text-indent:="" 0px;text-transform:="" none;widows:="" 2;word-spacing:="" 0px;-webkit-text-stroke-width:="" 0px;white-space:="" normal;text-decoration-thickness:="" initial;text-decoration-style:="" initial;text-decoration-color:="" initial;background-color:="" rgb(255,="" 255,="" 255);line-height:="" 1.75em;visibility:="" visible;box-sizing:="" border-box="" !important;overflow-wrap:="" break-word="" !important;"="" class="js_darkmode__134">

参考文献：

[1]Pathak C， Aggarwal N， Ranga S. Acute Leukaemia Presenting as Acute Liver Failure with Stage 1 Hepatic Encephalopathy. Journal of Medical Evidence。 2025， 6（2）： 175-177.

[2]Paixão F， Salvada A， Santos S， et al. Case Report： Conservative management of hemophagocytic lymphohistiocytosis with fulminant hepatic failure in a pediatric leukemia patient. Frontiers in Pediatrics。 2025， 13： 1719708.

[3]Latifi A， Soltani M， Satarzadeh M， et al. Acute Lymphoblastic Leukemia Presenting With Initial Hyperbilirubinemia and Significantly Elevated Liver Transaminases： A Rare Pediatric Case With Unadjusted Chemotherapy. Clinical Medicine Insights： Case Reports， 2025， 18： 11795476251351514.

[4]孙汀， 王春霞， 张育才. 儿童肿瘤相关性肝衰竭的诊断与治疗. 中国小儿急救医学， 2019， 26（1）： 5-8.

portant;overflow-wrap:="" break-word="" !important;"="">责任编辑：蔡璇

portant;overflow-wrap:="" break-word="" !important;"="">"；医学界"；力求所发表内容专业、可靠，但不对内容的准确性做出承诺；请相关各方在采用或以此作为决策依据时另行核查。