急性白血病并发急性肿瘤溶解综合征(附12例报告)

Acute leukemia complicated with acute tumor lysis syndrome

目的:探讨急性白血病(AL)患者化疗后并发急性肿瘤溶解综合征(ATLS)的高危因素、临床表现、预防及治疗。方法:对12例化疗后发生ATLS与未发生ATLS的急性白血病患者进行相关因素分析,并对发生ATLS的患者化疗前后各项生化指标进行分析。结果:发生ATLS的高危因素可能与外周血白细胞数量、骨髓幼稚细胞比例、生化中乳酸脱氢酶、血尿酸有关;ATLS均表现为高钾血症、高磷血症、高尿酸血症、低钙血症及肾功能损害,并且预后差,死亡率高。4例死亡,1例自动出院,6例及时治疗后完全缓解,1例部分缓解。结论:针对可能出现ATLS的患者进行早期预防、早期诊断、早期治疗是改善患者预后的关键。

Objective：To study the high risk factors, clinical manifestation, prognosis and treatment of the acute leukemia （AL） patients who developed acute tumor lysis syndrome （ATLS） after chemotherapy. Methods： The correlation factors were analyzed between 12 cases had ATLS and had not ATLS of acute leukemia after chemotherapy. Meanwhile, the blood biochemical changes of ATLS cases were analyzed. Rusults：The high risk factors of ATLS might be connected with blood white blood cell quantity, childish cell proportion in bone marrow, biochemistry lactate dchydrogcnasc （LDH） and blood uric acid. The blood biochemical indexes of ATLS patients were characterized by hyperkalemia, hyperphosphatcmia, hypcruricemia, hypocalcemia and damage of kidney function. The prognosis was bad and the death rate was high. In 12 cases, four died, one left hospital automatically, six had complete alleviation and one part alleviation after treated timely. Conclusion. The key to improve prognosis of ATLS is early prevention, early diagnosis and early treatment.