孟广强.高白细胞急性髓系白血病早期死亡临床分析[J].内科急危重症杂志,2019,25(2):113-115
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| DOI：10.11768/nkjwzzzz20190207 |
| 中文关键词: 高白细胞急性髓系白血病 早期死亡 白细胞淤滞 |
| 英文关键词: |
| 基金项目:北京市高层次卫生人才培养项目（No:2013215RC1438）；北京市西城区卫生和计划生育委员会青年科技人才（科技新星）培养项目（No:XWKX2018-05） |
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| 中文摘要: |
| 目的：探讨高白细胞急性髓系白血病（HAML）早期死亡的原因，分析其潜在危险因素。方法：回顾性分析67例初诊HAML患者（非M3型）在确诊后7d内早期死亡的病例（15例）和非早期死亡病例（52例）的临床特征。结果：15例（22.4%）早期死亡，原因分别为颅内出血（10例）、心力衰竭（2例）、肺栓塞（1例）、重度肺部感染（1例）及呼吸衰竭（1例）。早期死亡组白细胞淤滞分级评分（LGS）≥2分、外周血白细胞数、乳酸脱氢酶（LDH）及凝血功能异常发生率均高于非早期死亡组（P<0.05）。2组之间性别、年龄、初诊时外周血血红蛋白水平、血小板水平、骨髓原/幼细胞比例、法美英(FAB)分型、尿酸、肌酐的差异不明显（P>0.05）。Logistic回归分析表明，LDH为HAML患者早期死亡的危险因素。结论：白细胞淤滞、出血、脏器衰竭和感染是HAML早期死亡的主要原因。血LDH水平是HAML患者是否发生早期死亡的危险因素。 |
| 英文摘要: |
| Objective: To investigate the high risk factors related to early death (ED) of newly diagnosed hyperleukocytic acute myeloid leukemia (HAML). Methods: The clinical data of 67 patients with newly diagnosed HAML (non M3) were analyzed. Clinical and laboratory features of patients with ED (15 cases) and non-ED (52 cases) were comparatively evaluated. Results: ED occurred in 15 patients (22.4%). Causes of ED included intracranial hemorrhage (10 cases), heart failure (2 cases), pulmonary embolism (1 case), severe pulmonary infection (1 case), and respiratory failure (1 case). As compared with the non-ED group, the incidence of higher LGS (≥2), greater white blood cell count, higher LDH, and abnormal blood coagulation was significantly increased in ED group (P<0.05). There was no statistically significant difference in gender, age, hemoglobin level, platelet count, percentage of blasts, FAB subtypes, uric acid level and creatinine level between two groups (P>0.05). Logistic regression analysis showed that LDH was the risk factor for ED in newly diagnosed HAML. Conclusion: The major causes of ED in HAML include severe bleeding, leukostasis, organs failure and severe infection. LDH is the risk factor for ED in newly diagnosed HAML. |
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