86例急性白血病患者死亡情况分析

THE CAUSE OF DEATH OF ACUTE LEUKEMIA:ANALYSIS OF 86 CASES

目的 :探讨急性白血病病死率和死亡原因。方法 :5 6 8例急性白血病患者住院中死亡 86例患者的资料进行分析。结果 :总病死率 15 %。慢粒急变 44 % ,复治 2 3% ,初治 12 .5 % (P <0 .0 1)。早期死亡病死率 38%。颅内出血 48.8% ,感染 31.4%。颅内出血发生率 :早期死亡 91% ,急非淋 5 5 % ,急淋 2 5 % (P<0 .0 5 )。M3 85 % (P<0 .0 1)。初治及复治的颅内出血发生率为 5 0 %、40 % (P>0 .0 5 )。严重血小板减少、高白细胞血症、凝血机制异常是颅内出血的重要原因。感染是后期死亡的主要原因 (4 9% )。G-菌感染率 :血 87% ,呼吸道 79% ,皮肤软组织 6 2 % ,真菌感染率48%。结论 :1急性白血病的病死率高 ,且慢粒急变 >复治 >初治 ,相互之间差异有显著性 (P<0 .0 1)。2颅内出血是急性白血病的重要死亡原因和早期死亡主要原因 ,且与 FAB分型是有关。3感染是急性白血病第 2位的死亡原因。G-菌是急性白血病感染的主要原因 。

Objective:To investigate mortality and the cause of death of acute leukemia.Methods:86 deadly patients with acute leukemia were restrespectivly analyzed.Results:The total mortality of acute leukemia was 15%,44% for chronic myeloid leukemia in blast crisis,23% for relapsed patieats and 12.5% for those previously untreated( P <0.01).The mortality at early stage was 38%,48% and 31.4% for cerebral hemorrhage and infection,respectively.Among cerebral hemorrhage patients,91% died early,55%,25% and 85% died of acute nonlymphoblastic leukemia,acute lymphoblastic leukemia and acute promyelocytic leukemia,respectively.The incidence of newly diagnosed and previously treated cerebral hemorrhage was 50% and 40%,respectively,( P >0.05),The major cause of cerebral homorrhage are severe thrombo cytopenia,neutrephilia and abnormal coagulation,while the injection is the prominent cause of death at late stage.The mortality due to infection was 49% gram negative bacteria infection in blood culture was 87%,in respiratory was 79%,in integument was 62%.The incidence of fungal infection is 48%.Conclusion:The mortality of acute leukemia was very high.the highest is occured to the case of acute transformation,the second is the retreated,and the previous untreated had less high.It shows markedly significance( P <0.01).Cerebral hemorrhage was the first cause of death at early clinical stage,which was significantly associated with FAB type.Infection is the second cause gram regative bacteria infection was eminent.while fungal infection was also involved.