急性早幼粒细胞白血病出血相关早期死亡危险因素分析

Risk factors for hemorrhage related early death in patients with acute promyelocytic leukemia

目的探讨初发急性早幼粒细胞白血病(acute promyelocytic leukemia, APL)患者出血相关早期死亡的发生率、原因和危险因素。方法行单药亚砷酸诱导治疗的初发APL患者409例,记录出血相关早期死亡发生率和原因;选取年龄、性别、白细胞计数、血小板计数、纤维蛋白原、D-二聚体、白蛋白、谷草转氨酶、肌酐、尿酸10个参数,采用Cox回归分析出血相关早期死亡的危险因素。结果 409例患者中44例发生出血相关早期死亡,诱导治疗30 d时累积出血相关早期死亡发生率为11.58%;出血相关早期死亡的原因依次为脑出血、播散性血管内凝血、消化道出血。多因素Cox回归分析结果显示,白细胞计数>10×10~9/L(HR=4.424,95%CI:2.308~8.483,P<0.001)、纤维蛋白原<1.0 g/L(HR=2.248,95%CI:1.220~4.145,P=0.009)、高肌酐(HR=2.459,95%CI:1.026~5.891,P=0.044)和低白蛋白血症(HR=2.684,95%CI:1.234~5.840,P=0.013)是APL患者出血相关早期死亡的独立危险因素。结论白细胞计数、纤维蛋白原、肌酐和白蛋白是APL患者出血相关早期死亡的独立预测因素。

Objective To explore the incidence,causes and risk factors of hemorrhage related early death in patients with newly diagnosed acute promyelocytic leukemia(APL).Methods The clinical data of 409 consecutive patients with newly diagnosed APL were retrospectively analyzed.All patients received arsenic trioxide as induction therapy.The incidence and cause of hemorrhage related early death were recorded,Cox regression analysis was used to evaluate the risk factors for hemorrhage related early death by selecting parameters age,sex,white blood cell count,platelet count,fibrinogen,D-dimer,albumin level,glutamic oxaloacetic transaminase,creatinine and uric acid.Results Of 409 patients,hemorrhage related early death occurred in 44.The cumulative incidence of hemorrhage related early death after 30-day induction therapy was 11.58%.Hemorrhage related early death was mainly caused by cerebral hemorrhage,followed by disseminated intravascular coagulation and gastrointestinal hemorrhage in turn.White blood cell count>10×10^9/L(HR=4.424,95%CI:2.308-8.483,P<0.001),fibrinogen<1.0 g/L(HR=2.248,95%CI:1.220-4.145,P=0.009),high creatinine level(HR=2.459,95%CI:1.026-5.891,P=0.044)and hypoalbumimemia(HR=2.684,95%CI:1.234-5.840,P=0.013)were the independent risk factors for hemorrhage related early death in patients with APL.Conclusion White blood cell count,fibrinogen level,creatinine level and albumin level are the independent predictive factors for hemorrhage related early death in patients with APL.