汪智琼.急性髓系白血病伴巨核系发育异常的临床特征及预后研究[J].内科急危重症杂志,2023,29(1):18-22
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| DOI：10.11768/nkjwzzzz20230105 |
| 中文关键词: 巨核系发育 急性髓系白血病 预后不良 |
| 英文关键词: |
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| 中文摘要: |
| 摘要 目的：研究急性髓系白血病（AML）伴巨核系发育异常的临床特征及预后，进一步探讨影响AML预后的危险因素。方法：收集81例进行小巨核酶标染色的初诊AML患者，其中伴巨核系发育异常的43例为观察组，巨核系发育正常的38例为对照组，回顾性比较治疗前2组的临床特征、骨髓细胞形态学、融合基因、基因突变、染色体核型等以及治疗后2组初次诱导化疗的疗效及总生存期。结果：2组临床特征比较,差异无统计学意义（P均>0.05），2组骨髓细胞形态学上，FAB分型以AML-M2型为主，观察组骨髓原始细胞占比低于对照组\[(43.21±20.64)% vs (57.30±22.49)%，P<0.05\]。观察组多基因突变(≥3个基因)的概率更高(37.3% vs 13.3%,P<0.01)，核型程度较不复杂，正常核型占比高（54.1% vs 39.4%，P=0.02）。AML标准化疗方案初次诱导1个疗程后，观察组完全缓解（CR）、部分缓解（PR）、未缓解（NR）率分别为8%、44%、48%，对照组分别为12.0%、64.0 %、24.0%，差异有统计学意义(P均<0.05)。观察组总生存期短于对照组(11个月 vs 23个月，P<0.05)。结论：AML伴巨核系发育异常的患者多基因突变概率更高、CR率较低、生存期较短、预后较差，巨核系发育异常是AML预后不良的危险因素之一。 |
| 英文摘要: |
| Abstract Objective: To study the clinical characteristics and prognosis of acute myeloid leukemia (AML) with abnormal megakaryus and investigate the risk factors of AML. Methods: A total of 81 initial AML patients with small megakarycle enzyme label staining were collected, including 43 patients with abnormal megakaryus development in the observation group and 38 patients with normal megakaryus development in the control group. Clinical characteristics, bone marrow cell morphology, fusion gene, gene mutation and chromosome karyotype of the two groups before treatment were retrospectively compared, as well as the efficacy and overall survival of the two groups after initial induction chemotherapy. Results: The clinical characteristics of two groups showed no statistically significant difference (P>0.05). Morphology of bone marrow cells in two groups revealed the predominant AML-M2 of FAB typing. The proportion of bone marrow primitive cells in the observation group was significantly lower than in the control group \[(43.21 ± 20.64)% vs (57.30 vs 22.49)%, P<0.05\]. The probability of multiple gene mutations (≥3 genes) was higher in the observation group (37.3% vs 13.3%, P<0.001) and the percentage of the normal karyotype was higher (54.1% vs 39.4%, P=0.02) than in the control group. After the initial induction of standard chemotherapy regimen for one course of treatment, the rates of complete remission (CR), partial remission (PR) and unremission (NR) were 8%, 44% and 48% in the observation group, and 12%, 64% and 24% in the control group, respectively, with the difference being significant (P<0.05). The median survival was 11 and 23 months in the observation group and in the control group, respectively. The overall survival in the observation group was significantly shorter than that in the control group (P<0.05). Conclusion: AML patients with megakaryocyte dysplasia have a higher probability of multiple gene mutations, lower CR rate, shorter survival and poorer prognosis, and megakaryocyte dysplasia is one of the risk factors for poor prognosis of AML. |
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