急性淋巴细胞白血病患者巩固维持期中枢神经系统受累的影响因素及生存率随访分析  

Follow-up analysis of influencing factors and survival rate of central nervous system involvement in patients with acute lymphoblastic leukemia during consolidation and maintenance period

作　　者：赵孟霞[1] 何继祥 陈建行 李章坤 ZHAO Meng-xia;HE Ji-xiang;CHEN Jian-xing;LI Zhang-kun(Hematopoietic Stem Cell Transplantation Center,the Tenth Affiliated Hospital of Southern Medical University·Dongguan People's Hospital,Dongguan 523000,Guangdong,China)

机构地区：[1]南方医科大学第十附属医院·东莞市人民医院造血干细胞移植中心,广东东莞523000

出　　处：《川北医学院学报》2024年第4期506-510,共5页Journal of North Sichuan Medical College

基　　金：广东省东莞市社会科技发展(重点)项目(202050715001214)。

摘　　要：目的:探讨急性淋巴细胞白血病(ALL)患者巩固维持期发生中枢神经系统受累及患者生存率的影响因素。方法:选取120例ALL巩固维持期患者为研究对象,根据是否出现中枢神经系统白血病(CNSL)分为CNSL组(n=40)和非CNSL组(n=80)。比较两组患者一般资料及CNSL组不同预后患者临床特征;Logistic回归分析ALL巩固维持期CNSL发生的危险因素;随访1年CNSL患者生存情况,多因素Cox比例风险模型分析1年生存率的影响因素。结果:两组患者性别、年龄、体质量指数、形态学分型、肝脾肿大情况比较,差异无统计学意义(P>0.05);CNSL组患者危险度分型为高危、免疫分型T型、初诊白细胞计数水平≥100×10^(9)/L、初诊血清LDH水平≥1000 U/L的占比高于非CNSL组(P<0.05)。回归分析显示,危险度分型为高危、免疫分型T型、初诊白细胞计数水平≥100×10^(9)/L、初诊血清LDH水平≥1000 U/L是ALL巩固维持期CNSL发生的独立危险因素(P<0.05)。随访1年,CNSL患者生存25例,死亡15例,死亡率为37.50%;不同预后CNSL患者性别、年龄、CNSL诊断时血清LDH水平、合并与未合并其他髓外浸润情况患者生存情况比较,差异无统计学意义(P>0.05);死亡组患者CNSL诊断时外周血白细胞计数水平≥100×10^(9)/L的比例高于生存组(P<0.05),1个疗程达完全缓解比例低于生存组(P<0.05);多因素Cox比例风险模型分析结果表明,外周血白细胞计数水平≥100×10^(9)/L、1个疗程未达完全缓解是CNSL患者1年生存率的独立影响因素(P<0.05)。结论:高危危险度分型、免疫分型T型、初诊白细胞计数水平高、LDH高表达均可导致ALL患者巩固维持期CNSL风险升高,且CNSL发生后患者外周血白细胞计数水平高、1个疗程未达完全缓解均可导致预后不良。Objective:To investigate the influencing factors of central nervous system involvement in patients with acute lymphoblastic leukemia(ALL)during consolidation and maintenance period,and to analyze the survival rate of the disease.Methods:120 patients with ALL during the consolidation and maintenance period were selected as the research subjects,and they were divided into CNSL group(n=40)and non CNSL group(n=80)according to the presence of central nervous system leukemia(CNSL).The general information between two groups and clinical characteristics of patients with different prognoses in the CNSL group were compared.Logistic regression analysis was used to analyze the risk factors of CNSL during the consolidation and maintenance period of ALL.Follow up the survival status of CNSL patients for 1 year,and the influencing factors of 1-year survival rate using a multivariate Cox proportional hazards model were analyzed.Results:There was no significant difference in gender,age,body mass index,morphological classification,and hepatosplenomegaly between the CNSL group and the non-CNSL group(P>0.05).The proportion of high risk type,immune type T,white blood cell count level≥100×10^(9)/L and serum LDH level≥1000 U/L in CNSL group was higher than that in non-CNSL group(P<0.05).Logisitic regression analysis showed that high risk type,immune type T,white blood cell count level≥100×10^(9)/L and serum LDH level≥1000 U/L were independent risk factors for central nervous system involvement in ALL patients during consolidation and maintenance period.40 patients with CNSL were followed up for 1 year,including 25 survivors and 15 deaths,with a mortality rate of 37.50%.There was no statistically significant difference in gender,age,serum LDH levels at CNSL diagnosis,and survival between patients with and without other extramedullary infiltrations among different prognoses of CNSL(P>0.05).The proportion of peripheral blood leukocyte count levels≥100×10^(9)/L in the death group patients diagnosed with CNSL was higher than th

关 键 词：急性淋巴细胞白血病 巩固维持期 中枢神经系统受累 影响因素 生存率 

分 类 号：R733.71[医药卫生—肿瘤]