初诊危重急性髓系白血病的临床特征及预后分析  

Clinical characteristics and prognostic analysis of newly diagnosed acute myeloid leukemia with critical illness

作　　者：梁佩淇 高梦 谢妍 李冰清 李倩[1] 刘子溢 王栋 仇惠英[1] 陈苏宁[1] 吴德沛[1] 付建红[1] Liang Peiqi;Gao Meng;Xie Yan;Li Bingqing;Li Qian;Liu Ziyi;Wang Dong;Qiu Huiying;Chen Suning;Wu Depei;Fu Jianhong(National Clinical Research Center for Hematologic Diseases,the First Affiliated Hospital of Soochow University,Department of Hematology,Intensive Care Unit,Jiangsu Institute of Hematology,Suzhou 215006,China)

机构地区：[1]国家血液系统疾病临床医学研究中心,苏州大学附属第一医院血液科重症监护病房,江苏省血液研究所,苏州215006

出　　处：《中华血液学杂志》2025年第1期39-44,共6页Chinese Journal of Hematology

基　　金：白求恩公益基金会课题(2022-YJ-085-J-Z-ZZ-022);苏州大学横向研究课题(H211284)。

摘　　要：目的回顾性分析初诊危重急性髓系白血病(AML)收住血液专科重症监护病房(HCU)患者的临床特征,分析AML危重症出现的特点和早期死亡相关因素。方法收集2020年10月至2024年10月苏州大学附属第一医院HCU收治的91例初诊AML患者的临床资料,分析患者收住HCU的原因及HCU的主要治疗措施,分析危重患者早期死亡的危险因素。结果初诊AML患者从诊断至入HCU的中位时间为3(3,9)d,中位住HCU天数为10(3,23)d,71例患者在诱导化疗前收住HCU,20例在诱导化疗开始后转入HCU。收入HCU的最主要原因为肺部感染(78.0%),其次分别是呼吸衰竭(44.0%)、肝功能不全(28.6%)、肾功能不全(27.5%)、弥散性血管内凝血(DIC)(25.3%)和脓毒症(23.1%),入HCU时中位急性生理与慢性健康Ⅱ评分(APACHEⅡ评分)14(11,18)分,中位脓毒症序贯器官衰竭评分(SOFA评分)7(4,10)分,HCU的主要救治措施包括血管活性药物、无创机械通气、连续性肾脏替代治疗、有创机械通气及治疗性白细胞清除。接受诱导化疗的患者复合完全缓解率及总体缓解率分别为65.4%和88.5%。35例(38.5%)患者在入HCU后28 d内死亡,DIC(OR=9.350,95%CI 1.999~43.745,P=0.005)、脓毒症(OR=6.817,95%CI 1.571~29.582,P=0.010)及心功能不全(OR=12.281,95%CI 2.385~63.254,P=0.003)是患者28 d死亡的独立危险因素。结论初诊危重AML患者入住HCU的主要原因为肺部感染,近四成患者早期死亡,DIC、脓毒症及心功能不全是影响早期死亡的因素。ObjectiveThis study retrospectively analyzed the clinical characteristics of patients newly diagnosed with acute myeloid leukemia(AML)who were admitted to the hematology intensive care unit(HCU)with critical illness.It also examined factors associated with critical illness and early mortality in these patients.MethodsClinical data were collected from 91 newly diagnosed AML patients admitted to the HCU of the Department of Hematology,First Affiliated Hospital of Soochow University,from October 2020 to 2024.Reasons for HCU admission,major therapeutic interventions,and risk factors for critical illness and early mortality were analyzed.ResultsThe median time from diagnosis to HCU admission was 3 days(IQR:3–9 days),and the median HCU stay was 10 days(IQR:3–23 days).Of the 91 patients,71 were admitted to the HCU before induction chemotherapy,while 20 were transferred to the HCU after its initiation.The leading causes of HCU admission were pulmonary infection(78.0%),respiratory failure(44.0%),hepatic insufficiency(28.6%),renal insufficiency(27.5%),disseminated intravascular coagulation(DIC;25.3%),and sepsis(23.1%).Median Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)and SOFA scores at HCU admission were 14(IQR:11–18)and the median Sepsis Related Organ Failure Assessment(SOFA)score was 7(IQR:4,10).Major HCU interventions included vasoactive drugs,noninvasive and invasive mechanical ventilation,continuous renal replacement therapy,therapeutic leukocyte clearance,and cardiopulmonary resuscitation.Among patients receiving induction chemotherapy,the composite complete remission rate was 65.4%,and the overall remission rate was 88.5%.Thirty-five(38.5%)patients died within 28 days of HCU admission.Independent risk factors for 28-day mortality were DIC(OR=9.350,95%CI 1.999–43.745,P=0.005),sepsis(OR=6.817,95%CI 1.571–29.582,P=0.010),and cardiac insufficiency(OR=12.281,95%CI 2.385–63.254,P=0.003).ConclusionThe main reason for HCU admission in newly diagnosed critically ill AML patients was pulmonary inf

关 键 词：白血病 髓系 急性 重症监护病房 危重 早期死亡 

分 类 号：R73[医药卫生—肿瘤]