儿童急性白血病42例的死亡原因及相关因素  

Dead Reasons and Related Factors of 42 Cases with Acute Leukemia in Chinldren

作　　者：赵玉红[1] 佟莉贞[1] 

机构地区：[1]广州市儿童医院血液肿瘤科,广州510120

出　　处：《实用儿科临床杂志》2009年第3期211-213,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨儿童急性白血病(AL)在院死亡原因及相关因素。方法回顾性分析广州市儿童医院1999年1月-2007年3月收治的42例AL患儿死亡病例资料。男19例,女23例;年龄4个月～12岁5个月。42例中急性淋巴细胞性白血病(ALL)21例,急性髓细胞性白血病(AML)18例,未分型3例。结果12例患儿未经治疗早期死亡者10例,分别死于疾病浸润和颅内及肺出血。接受化疗的30例中早期死于出血者4例,中后期多死于骨髓抑制并发的感染,其中败血症14例,真菌感染3例,病毒感染1例,不明病原4例。23例化疗后完全缓解者中,复发16例(70%),累计28例次,50%发生在初治1a内。治疗相关死亡27例,占治疗总数的90%,主要死因为感染,其次为出血。细菌居感染病原之首。初诊时出血及高白细胞血症是白血病早期死亡的2大危险因素。结论应重视并纠正儿童AL治疗早期出血倾向,尤其是急性早幼粒细胞白血病。积极防治诱导化疗中感染并发症,降低化疗相关病死率。Objective To explore the dead reasons and related factors of acute leakemia（AL） in children. Methods The clinical data of 42 dead cases of children with AL,who were admitted to Guangzhou Children＇s Hospital between Jan. 1999 and Mar. 2007 were reviewed. Nineteen cases were boys,23 cases were girls;the aging from4 months to 12 years old and 5 months. Of 42 children, 21 cases were acute lymphoblastic leukemia（ ALL）, 18 cases were acute myeloid leukemia（AML） ,3 cases were unclassified AL. Results Ten out of 12 early - dead cases died of bleeding. Among 30 cases who received chemotherapy, 4 cases died of bleeding, others of myelosuppression combined with infection, 14 of whom died from sepsis, 3 cases with fungal infection, 1 case with virus infection, 4 cases with unknown pathogens. Sixteen children relapsed among those who got remission, half of them relapsed within 1 year since diagnosed. Treatment - related mortality （ TRM ） was 90% （27 out of 30 cases）. The main causes of TRM were infection and hemorrhage. Hyperleukocytosis and bleeding were 2 risk factors related to early death in new - diagnosed children. Conclusions More emphasizes should be put on bleeding tendency during early treatment in children with AL and treatment of infection complications during induction chemotherapy to reduce TRM.

关 键 词：白血病 急性 死亡分析 儿童 

分 类 号：R733.71[医药卫生—肿瘤]