APL早期死亡原因分析.DOC

急性早幼粒细胞白血病早期死亡原因分析吴思静 杨时佳 李登举* 洪振亚 周剑峰 华中科技大学同济医学院附属同济医院血液科 （武汉 430030） 摘要 目的探讨急性早幼粒细胞白血病（APL）早期死亡因素。方法2012年8月至2014年7月收治分析早期死亡病例和非早期死亡病例临床特征。结果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）、白细胞淤滞症维甲酸综合征1例。WBC(10(109/L）早期死亡P=0.042）早期死亡凝血酶原时间（PT）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、骨髓早幼粒细胞百分比、活化的凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原、尿酸、肌酐的差异）早期死亡组LDH水平高于对照组±810.6 U/L和513.5±619.0U/L；早期死亡组高于对照组±72.0）(109/L和（13.8±23.5）(109/L；而早期死亡组血小板计数）低对照组±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）。结论：出血、感染白细胞淤滞症维甲酸综合症APL早期死亡的主要原因。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。 关键词急性早幼粒细胞白血病 早期死亡 出血感染 *通讯作者：李登举 lidengju@163.com 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 Abstract 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