380例急性白血病患者肿瘤溶解综合征发病率与危险因素分析

Analysis of Tumor Lysis Syndrome in 380 Cases of Acute Leukemia

目的:本研究旨在探讨初诊急性白血病(AL)患者肿瘤溶解综合征(tumor lysis syndrome,TLS)的发病率和疾病转归及相关危险因素。方法:分析380例急性白血病患者的临床表现及实验室检查结果,根据Cairo和Bishop标准判断患者是否发生TLS,并分析发病相关高危因素。结果:在380例急性白血病患者中79例发生TLS(20.8%),其中临床TLS(CTLS)2例(0.5%),实验室TLS(LTLS)77例(20.3%)。单因素分析发现,男性、肝脏肿大、脾脏肿大、淋巴结肿大、丙氨酸转氨酶(AST)升高、血肌酐升高、血尿酸升高、乳酸脱氢酶(LDH)升高和白细胞数升高均为TLS的发病危险因素。结论:TLS是急性白血病(尤其是诱导化疗期间)的常见并发症。对高危患者应予密切监测、预防及充分治疗。

Objective： This studay was aimed to explore the incidence and risk factors of tumor lysis syndrome （TLS） in patients with acute leukemia. Methods： A tatol of 380 patients who were newly diagnosed as acute leukemia and received combination chemotherapy were retrospectively analyzed. The TLS was diagnosed according to criteria of Cario and Bioshop, the risk factors were evaluated on basis of examination results. Results： The tumor lysis syndrome occurred in 20.8 % （79/380） of patients, out of them the clinical TLS was 0.5 % （2/380）, laboratorial TLS was 20.3 % （77/380）. The unvariate analysis showed that male, high WBC count, hepatomegaly, splenomegaly, lympha- denoctasis, elevated AST, high creatinine, high uric acid level, high serum lactate dehydrogenase（LDH） level, or renal insufficiency were independent risk factors for TLS. Conclusion： The TLS is a clinically common complication in patients with leukemia, especially during induction chemotherapy, therefore, for AL patients with high risk factors the TLS should be closely monitored, prevented and given better therapy.