目的:探讨初诊急性早幼粒细胞白血病(APL)患者的临床特点及早期死亡相关因素分析。
方法:本回顾性研究包括2010年1月至2022年8月在我院就诊并首次诊断为APL的患者。我们分析了他们的临床和实验室特征,并分析了与早期死亡相关的相关因素。
结果:共收集269例初步诊断为APL的患者。男女比例为6:5,中位年龄为42岁(范围7-80)。在最初诊断为APL的患者中,有34例早期死亡,导致13%的早期死亡率。从诊断到死亡的中位时间为8.5天(范围3-24)。早期死亡与未死亡患者临床特征的对比分析,使用逻辑回归模型,揭示了那个年龄,初始诊断时的白细胞计数(WBC),凝血酶原时间(PT)延长是原发性APL患者早期死亡的独立危险因素(P<0.05)。比较早期死亡组和非早期死亡组住院期间的临床特征,观察到,早期死亡患者住院期间的WBC日平均值显著高于未死亡患者(P<0.001).相反,早期死亡患者的每日平均血小板计数(PLT)显著低于未死亡患者(P<0.001).此外,PLT的平均每日输液量差异有统计学意义(P<0.05),纤维蛋白原(Fib)(P<0.05),早期死亡和未死亡患者住院期间的新鲜冰冻血浆(FFP)(P<0.05)。具体来说,早期死亡组的PLT和FFP每日平均输注量显著高于非早期死亡组.在34位早期死亡患者中,有25位(74%)被确定为死亡的直接原因。其余死亡原因包括5例(15%)感染,所有这些都是严重的肺部感染,包括2例联合辨证,4例患者(11%)在初次诊断时放弃治疗。
结论:在原发性APL患者中,年龄,初次诊断时白细胞,PT时间延长是早期死亡的独立危险因素(P<0.05)。住院期间WBC和PLT的实验室检查结果,以及PLT的输注,Fib,住院期间的FFP,也具有统计学意义。脑出血是原发性APL患者早期死亡的主要原因。
OBJECTIVE: The objective of this study was to investigate the clinical characteristics and analysis of related factors associated with early death in newly diagnosed patients with acute promyelocytic leukemia (APL).
METHODS: This retrospective study included patients who visited our hospital between January 2010 and August 2022 and were diagnosed with APL for the first time. We analyzed their clinical and laboratory characteristics and analysis of related factors associated with early death.
RESULTS: A total of 269 patients with a primary diagnosis of APL were collected. The male to female ratio was 6:5, and the median age was 42 years (range 7-80). Among patients with initial APL diagnosis, there were 34 early deaths, resulting in an early mortality rate of 13%. The median time from diagnosis to death was 8.5 days (range 3-24). Comparative analysis of the clinical characteristics between patients who died early and those who did not, using a logistic regression model, revealed that age, white blood cell count (WBC) at initial diagnosis, and prolongation time of prothrombin time (PT) were independent risk factors for early death in patients with primary APL (P < 0.05). Comparing the clinical characteristics during hospitalization between the early death group and the non-early death group, it was observed that the daily mean of WBC during hospitalization was significantly higher in patients who died early than in those who did not (P < 0.001). Conversely, the daily mean of platelet count (PLT) was significantly lower in patients who died early compared to those who did not (P < 0.001). Furthermore, statistically significant differences were found in the mean daily infusion of PLT (P < 0.05), fibrinogen (Fib) (P < 0.05), and fresh frozen plasma (FFP) (P < 0.05) during hospitalization between patients who died early and those who did not. Specifically, the mean daily infusion of PLT and FFP was significantly higher in the early-death group than in the non-early-death group. Cerebral hemorrhage was identified as the immediate cause of death in 25 out of the 34 early-death patients (74%). The remaining causes of death included infection in 5 cases (15%), all of which were severe pulmonary infections, including 2 cases of combined differentiation syndrome, and abandonment of treatment in 4 patients (11%) at initial diagnosis.
CONCLUSIONS: In patients with primary APL, age, WBC at initial diagnosis, and PT prolongation time were identified as independent risk factors for early death (P < 0.05). Laboratory findings regarding WBC and PLT during hospitalization, as well as the infusion of PLT, Fib, and FFP during hospitalization, were also statistically significant. Cerebral hemorrhage was found to be the main cause of early death in patients with primary APL.