血小板输注疗效影响因素探究及其与预后的关系  

Study on the factors affecting the therapeutic effect of platelet transfusion and its relation with prognosis

作　　者：张敏敏 肖翡 李娟[1] 童秀珍[1] 周振海[1] 郑冬[1] ZHANG Minmin;XIAO Fei;LI Juan;TONG Xiuzhen;ZHOU Zhenhai;ZHENG Dong(Department of Hematology,the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China;Emergency Department,the First Affiliated Hospital, Jinan University, Guangzhou 510315, China)

机构地区：[1]中山大学附属第一医院血液内科,广东广州510080 [2]暨南大学附属第一医院急诊科,广东广州510315

出　　处：《暨南大学学报（自然科学与医学版）》2020年第4期351-357,共7页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：广东省医学科学技术研究基金项目(A2016109);广东省级产业技术研究与开发专项资金项目(20160906)。

摘　　要：目的:研究影响急性白血病患者血小板输注疗效的相关因素,探究输注疗效对患者预后的影响.方法:对中山大学附属第一医院血液内科113例急性白血病(AL)患者预防性输注的1921次血小板的影响因素进行分类分析,并依据血小板增加指数值(CCI),将患者分为血小板输注有效组和无效组,对无效组及有效组患者进行预后分析.结果:血小板输注疗效与患者起病时的血象、脾脏大小有关,而与患者的年龄、性别、血型、疾病类型等并无统计学差异.无效组患者死亡率(45.2%)高于有效组患者(25.8%),且有统计学差异(P<0.05).急性淋巴细胞白血病(ALL)患者无效组中位生存期(10.4月)远低于有效组(17.2月),具有统计学差异(P<0.05),急性髓系白血病(AML)患者无效组及有效组中位生存期均未到达,两组无统计学差异(P>0.05).结论:起病时伴有贫血(血红蛋白质量浓度<60 g/L)、血小板降低(血小板计数<20×109/L)、白细胞升高(白细胞计数>50×109/L)等血象异常的急性白血病患者更易发生血小板输注无效,血小板输注无效的患者的疾病预后差于输注有效的患者.Objective:To investigate the influence factors on platelet transfusion efficacy in patients with acute leukemia(AL)and the relationship between platelet transfusion efficacy and prognosis.Methods:A total of 113 patients with AL department of hematology,the first affiliated hospital of Sun Yat-sen University,were grouped into effective group and invalid group according to the calculation of the corrected count of increment(CCI).Meanwhile,data of the factors affecting the total prophylactic 1921 platelet transfusion in the patients and the prognosis of the two groups were statistically analyzed.Results:The result shows that the hemogram and the size of the spleen of patients newly diagnosed will affect the platelet transfusion efficiency,while there is no significant correlation between transfusion efficiency and patients'age,gender,blood type and the type of AL.The mortality rate in efficient group(25.8%)is lower than that of invalid group(45.2%),which is statistically significant(P<0.05).Median survival time for patients with acute lymphoblastic leukemia(ALL)in effective group is 17.2 months and 10.4 months(P<0.05)in invalid group.Patients with acute myeloid leukemia in both groups don't get through the median survival time.Conclusion:Patients newly diagnosed with the abnormal hemogram such as anemia(HB<60 g/L),platelet reduction(PLT<20×109/L)and elevated white blood cells(WBC>50×109/L)were susceptible to platelet transfusion refractoriness(PTR).And AL patients who fail to respond to platelet transfusion have a less favorable prognosis compared with the efficient group.

关 键 词：预防性血小板输注 急性白血病(AL) 血小板输注无效(PTR) 预后 

分 类 号：R557.1[医药卫生—血液循环系统疾病]