高白细胞急性白血病早期死亡的危险因素分析  

Analysis of risk factors for early death in hyperleukocytic acute leukemia

作　　者：苏明环 阎嶂松 李秋玲 张家源 尹延珂 胡波 刘永泽 李大鹏 秘营昌 Su Minghuan;Yan Zhangsong;Li Qiuling;Zhang Jiayuan;Yin Yanke;Hu Bo;Liu Yongze;Li Dapeng;Mi Yingchang(State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China;Tianjin Institutes of Health Science,Tianjin 301600,China)

机构地区：[1]中国医学科学院血液病医院(中国医学科学院血液学研究所),血液与健康全国重点实验室,国家血液系统疾病临床医学研究中心,细胞生态海河实验室,天津300020 [2]天津医学健康研究院,天津301600

出　　处：《中华血液学杂志》2025年第1期53-57,共5页Chinese Journal of Hematology

基　　金：国家血液系统疾病临床医学研究中心临床研究基金(2023NCRCA0116)。

摘　　要：目的总结高白细胞急性白血病(HAL)患者的临床特征,分析该类患者早期死亡的危险因素,为判断早期预后提供依据。方法回顾性收集2019年7月1日至2021年11月30日就诊于中国医学科学院血液病医院急救中心的211例原发、初治HAL患者的临床资料,分析各指标对早期危险分层及预后的价值。结果①34例(16.1%)患者早期死亡,早期死亡组患者WBC、外周血原始幼稚细胞比例、凝血酶原时间(PT)、纤维蛋白原降解产物(FDP)、D-二聚体水平均高于非早期死亡组(P值均<0.05);②高白细胞急性髓系白血病患者的死亡率(20.5%)高于高白细胞急性淋巴细胞白血病患者(9.3%)(P<0.05),两组患者的年龄、肌酐、PT、纤维蛋白原(FIB)水平、WBC、乳酸脱氢酶(LDH)、尿酸、血钾、血钙、血磷水平差异均有统计学意义(P值均<0.05);③当WBC界值为255.96×10^(9)/L时,预测患者的早期死亡率敏感度为65.6%,特异度为69.0%,WBC水平高于此值患者的死亡率是低于此值患者的5.164倍(P值<0.05);④就诊时患者的年龄、WBC、LDH、尿素、PT、FDP、D-二聚体是影响HAL患者生存的危险因素(P值均<0.05)。结论HAL病情凶险,早期死亡率高,年龄、WBC、LDH、尿素、PT、FDP、D-二聚体是HAL患者发生早期死亡的危险因素。ObjectiveThis study analyzed the clinical characteristics and early mortality risk factors in patients with hyperleukocytic acute leukemia(HAL)to provide a basis for predicting early prognosis.MethodsData were retrospectively collected from 211 patients with primary HAL who visited the Emergency Center of the Hematology Hospital,Chinese Academy of Medical Sciences,between July 1,2019 and November 30,2021.The value of each indicator in early risk stratification and prognosis was analyzed.ResultsThe early-death group exhibited higher WBC,peripheral blood immature cell proportions,prothrombin times(PT),fibrinogen degradation products(FDP),and D-dimer levels than the non-early death group(P<0.05).Mortality in hyperleukocytic AML(20.5%)was significantly higher than that in hyperleukocytic ALL(9.3%)(P<0.05).There were significant differences in age,creatinine,PT,fibrinogen(FIB)levels,WBC,lactic dehydrogenase(LDH),uric acid,blood potassium,blood calcium,and blood phosphorus levels between the two groups of patients(P<0.05).A WBC threshold of 255.96×10^(9)/L predicted early mortality with 65.6%sensitivity and 69.0%specificity,with higher WBC levels associated with a 5.164-fold increased mortality risk(P<0.05).The age,WBC,LDH,urea,PT,FDP and D-dimer of patients at the time of consultation are risk factors affecting the survival of HAL(P<0.05).ConclusionHAL is a life-threatening condition with a high early mortality.Age,WBC,LDH,urea,PT,FDP and D-dimer are risk factors for early death in HAL.

关 键 词：高白细胞急性白血病 白细胞淤滞症 肿瘤溶解综合征 早期死亡率 预后 

分 类 号：R73[医药卫生—肿瘤]