恶性血液病患者化疗后出血与血小板计数和白细胞计数的关系

White blood cell and platelet count of post-chemotherapy hemorrhage in patients with hematologic malignancies

目的探讨恶性血液病患者化疗后出血的与白细胞和血小板计数的关系。方法观察96例恶性血液病化疗后的临床出血情况,监测出血时血小板计数、化疗前白细胞计数。比较不同年龄组、性别、疾病缓解状态的出血发生率;分析出血程度与血小板减少程度、白细胞计数的关系。结果 96例恶性血液病患者化疗后出血28例(ALL4例,AML(非M3型)16例,NHL1例,MM2例,HL1例,MDS4例),出血发生率为29.2%;≥55岁组出血发生率为44.2%(23/52),明显高于<55岁组(11.4%,5/44)(χ~2=12.462,P<0.05),而不同性别患者化疗后出血发生率的差异无统计学意义(P>0.05)。缓解组患者化疗后出血发生率为15.21%;未缓解组患者出血发生率为42.0%,较缓解组患者出血发生率高(χ~2=8.318,P<0.05)。出血患者均有血小板减少,1-2级出血组和3-4级出血组患者的血小板减少程度的差异有统计学意义(χ~2=13.38,P<0.01)。白细胞计数≥50×109/L的急性白血病患者出血患者3-4级的出血发生率高于白细胞计数<50×109/L的患者,差异有统计学意义(χ~2=6.806,P<0.05)。结论年龄≥55岁、恶性血液病未缓解可能为出血的危险因素;白细胞计数≥50×109/L可能为急性白血病患者3-4级出血的危险因素;血小板减少与恶性血液病患者出血相关,血小板<20×109/L时出血发生率明显增加。

Objective To investigate the relationship of post-chemotherapy bleeding and white blood cell and platelet count in patients with hematologic malignancies. Methods The post-chemotherapy bleeding events were observed in 96 patients with hematologic malignancies. Their platelet count was monitored when bleeding event occurred and white blood cell count before chemotherapy. Then,the incidence of bleeding were compared among groups of different age,gender,disease remission states. The severity of thrombocytopenia and leukocytosis were compared in correlation with the different bleeding states.Results Among 96 patients with hematologic malignancies,post-chemotherapy hemorrhage occurred in 28 cases（ ALL 4 cases,non-M3-AML 16 cases,NHL 1 case,MM 2 cases,HL 1 case,MDS 4 cases）,with an incidence of 29. 2%. The bleeding incidence was 44. 2%（23 /52） in the group consisting of patients over 55 year old,which was higher than the group less than 55 year old（11. 4%,5 /44）（ χ^2= 12. 462,P〈0. 05）. The incidence in different gender groups had no statistically significant difference（ P〉0. 05）. The post-chemotherapy bleeding incidence in the remission group was 15. 21%,but it was 42. 0% in the group without remission. The difference hemorrhage in non-remission and remission groups was statistically significant（ χ^2= 8. 318,P〈0. 05）. All cases of patients with post-chemotherapy hemorrhage experienced thrombocytopenia. The different degree of thrombocytopenia between the group of bleeding grade 1-2 and the group of bleeding grade 3-4 in patients of post-chemotherapy hemorrhage were statistically significant（ χ^2= 13. 38,P〈0. 01）. In patients with a bleeding grade of 3-4,the incidence of acute leukemia with white blood cell count more than 50 × 10^9/ L was higher than that with white blood cell count less than 50 × 10^9/ L,hence the difference was statistically significant（ χ^2= 6. 806,P〈0. 05）. Conclusion Old age and non-remission stage may be potential risk factors for post-chemotherapy hemorrhage in patients with hematologic malignancies. White blood cell count more than 50 × 10^9/ L is an indicative risk factor among patients with a bleeding grade 3-4 and acute leukemia. Post-chemotherapy hemorrhage in patients with hematologic malignancies is associated with the degree of thrombocytopenia.