伴急性肾损伤的初治急性早幼粒细胞白血病患者的临床特征分析
Clinical characteristics of newly diagnosed acute promyelocytic leukemia patients with acute kidney injury

付金月.伴急性肾损伤的初治急性早幼粒细胞白血病患者的临床特征分析[J].内科急危重症杂志,2026,32(2):130-135

DOI：10.11768/nkjwzzzz20260206

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作者	单位	E-mail
付金月		fansjhmu@163.com

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中文摘要:

摘要目的：分析伴急性肾损伤（AKI）的初治急性早幼粒细胞白血病（APL）重症患者的临床特征。方法：回顾性分析血液重症监护病房（HCU）中初治APL重症患者的临床资料，根据是否发生AKI将其分为非AKI组和AKI组。分析发生AKI的危险因素、病因和时间分布及其临床结局。结果：59例APL患者中有25例患者发生AKI；与非AKI组比较，AKI组患者入院时血白细胞（WBC）、肌酐（Cr)、总胆红素（TBIL）、乳酸脱氢酶（LDH）和降钙素原（PCT）显著升高，凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）显著延长，序贯器官衰竭评分（SOFA）更高。APTT（OR=1.216, 95%CI: 1.016~1.454, P=0.033）和SOFA评分（OR=1.280, 95% CI: 1.028~1.593, P=0.027）是发生AKI的独立危险因素。诱导治疗前有11例（44%）患者发生AKI，弥散性血管内凝血（DIC）是主要病因（9/25, 36%）；诱导治疗期间有12例（12/25,48%）患者发生AKI，分化综合征（DS）是主要病因（5/25,20%），其次是肿瘤溶解综合征（TLS）（4/25,16%）。诱导治疗结束后2例患者因脓毒症发生AKI。对比非AKI组，AKI组患者HCU中位住院时间更长（3d，IQR 2~9d vs. 2d,IQR 1~4d，P=0.043），早期死亡率更高（72.0% vs. 41.2%，P=0.019）。结论: 初治APL重症患者容易发生AKI，AKI的病因复杂且可能增加早期死亡风险，积极防治AKI可能降低早期死亡率。

英文摘要:

Abstract Objective: To analyze the clinical characteristics of critically ill patients with newly diagnosed acute promyelocytic leukemia (APL) complicated with acute kidney injury (AKI). Methods: A retrospective analysis was conducted on clinical data from critically ill patients with newly diagnosed APL admitted to the Hematology Intensive Care Unit (HCU). Patients were divided into non-AKI and AKI groups based on the occurrence of AKI. Risk factors, etiology, temporal distribution, and clinical outcomes of AKI were analyzed. Results: Among 59 patients with APL, 25 developed AKI. The AKI group had significantly higher admission levels of white blood cell count (WBC), creatinine (Cr), total bilirubin (TBIL), lactate dehydrogenase (LDH), and procalcitonin (PCT), as well as longer prothrombin time (PT) and activated partial thromboplastin time (APTT), and higher sequential organ failure assessment (SOFA) scores than the non-AKI group. APTT (OR=1.216, 95%CI: 1.016-1.454, P=0.033) and SOFA score (OR=1.280, 95%CI: 1.028-1.593, P=0.027) were independent risk factors for AKI. Before induction therapy, 11 patients (44%) developed AKI, with disseminated intravascular coagulation (DIC) being the predominant etiology (9/25, 36%). During induction therapy, 12 patients (12/25, 48%) developed AKI, with differentiation syndrome (DS) as the leading cause (5/25, 20%), followed by tumor lysis syndrome (TLS) (4/25, 16%). Two patients developed AKI due to sepsis after the completion of induction therapy. Compared with the non-AKI group, patients in the AKI group had a longer median HCU length of stay (3 days, IQR 2-9 vs. 2 days, IQR 1-4, P= 0.043) and a higher early mortality rate (72.0% vs. 41.2%, P=0.019). Conclusion: Critically ill patients with newly diagnosed APL are prone to AKI, which has complex etiologies and may increase the risk of early mortality. Active prevention and treatment of AKI may help reduce early mortality rates.