Ph阴性中老年急性淋巴细胞白血病诱导化疗继发高血糖的高危因素及对预后的影响

Hyperglycemia during chemotherapy in elderly Ph-negative acute lymphoblastic leukemia: risk factors and the impacts on prognosis

目的探讨Ph染色体核型阴性的中老年急性淋巴细胞白血病患者诱导化疗继发高血糖的发生率、高危因素及对预后的影响。方法回顾性分析血液科收治的68例初诊中老年Ph阴性急性淋巴细胞白血病患者的临床资料,所有患者均无糖尿病病史,诱导化疗均采用改良Hyper-CVAD方案,其中诱导化疗继发高血糖患者31例(继发高血糖组),未继发高血糖患者37例(非继发高血糖组),对比分析继发高血糖组患者的缓解率、继发真菌感染发生率、总生存率及继发高血糖的高危因素。结果诱导化疗继发高血糖的总发生率为45.5%(31/68),诱导化疗继发高血糖组患者与非继发高血糖组患者的完全缓解率差异无统计学意义(P>0.05);但继发真菌感染的发生率增加,总生存期缩短(P<0.05);多因素分析显示:患者疾病危险分层属于高危(OR=7.572)、初始LDH水平≥高限2倍(OR=4.642)、合并髓外侵犯(OR=5.426)是诱导化疗继发高血糖的高危因素(均P<0.05)。结论中老年急性淋巴细胞白血病患者诱导化疗继发高血糖的发生率相对较高,尤其是高危、初始高乳酸脱氢酶水平及伴有髓外侵犯的急性淋巴细胞白血病患者,预后不良。临床医生应提高对中老年白血病患者化疗合并症的认识,应将诱导化疗继发高血糖的监测及调控作为急性白血病整体治疗策略的一部分,对减少继发感染,改善患者长期预后具有重要意义。

Objective To investigate whether hyperglycemia during chemotherapy influences the prognosis of elderly Ph-negative acute lymphoblastic leukemia(ALL）,and the incidence and the risk factors of hyperglycemia. Methods The clinical medical records of 68 cases newly diagnosed patients with Ph-negative ALL in the People＇s Hospital of Dongguan city from January 2010 to December 2017 were retrospectively analyzed. All patients had no history of diabetes.The induction chemotherapy was performed with a modified Hyper-CVAD regimen. Results The total incidence of hyperthermia was 45. 5%. There was no significant difference in complete remission rate between hyperglycemia group and non-hyperglycemia group; but the incidence of secondary fungal infection was increased and the overall survival period was shortened in hyperglycemia group. Multivariate analysis showed that,high risk dangerous stratification,initial LDH level ≥2 times the upper limit and extramedullary violations were high risk factors for hyperthermia. Conclusion The incidence of hyperglycemia during chemotherapy in elderly patients with ALL is relatively high,especially in patients with high-risk,initial high LDH and extramedullary violations,suggesting a poor prognosis. The monitoring and regulation of hyperglycemia should be part of the overall treatment of leukemia.