急性早幼粒细胞白血病早期死亡原因分析
A analysis of causes related to early death for acute promyelocytic leukemia patients

吴思静,李登举.急性早幼粒细胞白血病早期死亡原因分析[J].内科急危重症杂志,2015,21(3):

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英文关键词:Acute promyelocytic leukemia Early death Hemorrhage Infection

基金项目:湖北省自然科学基金,编号2013CFB075；华中科技大学自主创新研究基金(重点专项项目)编号2014ZHYX023

作者	单位	E-mail
吴思静	华中科技大学同济医学院附属同济医院血液科武汉 430030	286030628@qq.com
李登举	华中科技大学同济医学院附属同济医院血液科武汉 430030	lidengju@163.com

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中文摘要:

目的: 探讨急性早幼粒细胞白血病（APL）早期死亡的原因，分析APL早期死亡的潜在危险因素。方法: 收集2012年8月至2014年7月收治的60例初诊APL患者的临床资料，回顾性分析APL患者在确诊后30天内早期死亡的病例（10例）和非早期死亡病例（50例）的临床特征。结果:10例（占16.7%）早期死亡，原因分别为颅内出血（5例）、重度肺部感染（3例）、白细胞淤滞症和维甲酸综合征各1例。预后分层属于高危组患者（即WBC?10?109/L）中，早期死亡组所占比例较非早期死亡组高（70% vs 30%，P=0.042）。早期死亡组凝血酶原时间（PT）均值和CD56阳性表达者比例也高于非早期死亡组（20.6s? 4.2 vs 17.5s? 4.1，P=0.032）（3/4 vs 1/41，P=0.007）。而两组之间年龄、性别、初诊时血红蛋白水平、骨髓早幼粒细胞百分比、活化的部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原、尿酸、肌酐的差异并不明显（P>0.05）。早期死亡组LDH水平高于对照组，分别为1115.6±810.6 U/L和513.5±619.0U/L；早期死亡组WBC也高于对照组，分别为（46.9±72.0）?109/L和（13.8±23.5）?109/L；而早期死亡组血小板计数（PLT）则低于对照组，分别为（16.9 ±14.7）?109/L和（36.2±38.9）?109/L。但在LDH、WBC和PLT方面的差异均无统计学意义（P>0.05）。结论：出血、感染、白细胞淤滞症和维甲酸综合症是APL早期死亡的主要原因。高危的预后分层、明显延长的PT或CD56的阳性表达均可能是初诊APL患者早期死亡的潜在危险因素。

英文摘要:

Objective: To retrospectively investigate the potential high risk factors of acute promyelocytic leukemia (APL) patients who developed early death (ED). Methods: Clinical and laboratory characteristics were retrospectively analyzed on 60 cases of newly-diagnosed APL for further investigation of the difference between early death cases and non-early death cases. Result: 10 cases (16.7%) had early death in 60 cases of newly-diagnosed APL. Causes of early death included intracranial hemorrhage (n=5), severe pulmonary infection (n=3), leukostasis complicated by pneumorrhagia (n=1) and retinoic acid syndrome (n=1), respectively. Compared with the non-early death cases, early death cases were with higher-risk prognosis(WBC?10?109/L) (P = 0.042),longer prothrombin time(PT) and higher CD56 positive expression rate (20.6?4.2 s vs 17.5?4.1s, P = 0.032)(3/4 vs 1/41, P=0.007).There was no statistically difference in age, gender, hemoglobin content, percentage of bone marrow promyelocytic cells, activated partial thromboplastin time(APTT),thrombin time (TT), fibrinogen, uric acid, and creatinine between two groups. Although there were higher leukocyte count and LDH level [(46.9±72.0) ?109/L vs (13.8±23.5)?109/L )](1115.6±810.6 U/L vs 513.5± 619.0 U/L),lower platelet count [(16.9 ±14.7)?109/L vs (36.2 ± 38.9)?109/L] in early death cases, it was no statistically significance between two groups(P>0.05). Conclusion: The major causes of early death in APL include severe bleeding, infection, leukostasis and retinoic acid syndrome. High-risk prognosis, longer prothrombin time and CD56 positive expression were potentially associated with ED in APL.