老年急性白血病患者并发2型糖尿病的临床观察和预后分析

Clinical observation and prognosis analysis of elderly patients with acute leukemia combined with type 2 diabetes mellitus

目的探讨老年急性白血病患者并发2型糖尿病的临床特征和预后情况。方法选取我院2014年1月~2016年12月收治的35例老年急性白血病并发2型糖尿病患者进行回顾性分析。根据患者诊治期间的血糖状态,分为观察组(血糖较高或波动状态)12例,对照组(血糖控制良好)23例,比较两组患者化疗期间的空腹血糖(FBG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)和血尿酸(UA)等糖尿病相关指标,并分析治疗效果、不良反应和远期生存时间的差异。结果白血病化疗期间,对照组的FBG、TC、LDL-C、UA水平均低于观察组,差异有统计学意义(P<0.05),两组的HDL-C、TG水平比较,差异均无统计学意义(P>0.05)。对照组的治疗有效率(91.30%)高于观察组(41.67%)(P<0.05)。不良反应主要包括酮症酸中毒、感染、神经系统症状、消化系统症状和白细胞减少,对照组的酮症酸中毒(0.00%)、感染(30.43%)和消化系统症状(13.04%)的不良反应发生率分别低于观察组(25.00%、66.67%、50.00%),差异有统计学意义(P<0.05),两组的其他不良反应发生率差异无统计学意义(P>0.05)。对照组(13.5个月)的中位生存时间长于观察组(6.75个月)(P<0.05)。结论老年急性白血病并发2型糖尿病患者应注意降糖治疗,血糖控制不良者具有疗效差、感染率高、预后不良等特点。

Objective To explore the clinical features and prognosis of elderly patients with acute leukemia combined with type 2 diabetes mellitus. Methods A total of 35 elderly patients with acute leukemia combine with type 2 diabetes mellitus were treated in our hospital from January 2014 to December 2016 were selected and retrospectively analyzed.According to the blood glucose status during diagnosis and treatment, they were divided into the observation group（n=12, high blood glucose or fluctuating state） and control group（n=23, good blood glucose control）. The fasting blood glucose（FBG）, total cholesterol（TC）, low density lipoprotein cholesterol（LDL-C）, high density lipoprotein cholesterol（HDL-C）, triglyceride（TG） and serum uric acid（UA） and other diabetes mellitus related indexes during chemotherapy were compared between the two groups, and the difference of treatment effect, adverse reactions and long-term survival time were analyzed. Results The levels of FBG, TC, LDL-C and UA in the control group were lower than those in the observation group during chemotherapy, and the differences were statistically significant（P〈0.05）, while there was no significant difference in the levels of HDL-C and TG between the two groups（P〈0.05）. The effective rate of the control group（91.30%） was higher than that of the observation group（41.67%）（P〈0.05）. Adverse reactions mainly included ketoacidosis, infection, nervous system symptoms, digestive system symptoms and leukopenia. The incidence of ketoacidosis（0.00%）, infection（30.43%） and digestive system symptoms（13.04%） in the control group was lower than those in the observation group（25.00%, 66.67%, 50.00%） respectively, and the difference was statistically significant（P〈0.05）. There were no significant difference in the incidence of other adverse reactions between the two groups（P〈0.05）. The median survival time in the control group（13.5 months） was longer than that in the observation group（6.75 months）（P〈0.05）.Conclusion The elderly patients with acute leukemia combined with type 2 diabetes should be paid attention to reduce blood glucose treatment, the patients with poor glycemic control have the characteristics of poor curative effect,high infection rate and poor prognosis.