309例初诊急性白血病患者临床特征与外周血象分析

Clinical features and peripheral hemogram analysis of 309 first-diagnosed acute leukemia patients

目的:通过分析初诊急性白血病(AL)患者的临床特征和外周血象变化的特点,进一步为AL诊治提供新依据。方法:回顾性分析2014年1月至2018年12月在温州医科大学附属第二医院育英儿童医院新确诊的AL患者(共309例)的临床症状、外周血象特点和诊断分型等资料。结果:大部分AL患者均出现一种或多种典型临床症状,其中以贫血(53.07%)和出血(42.39%)多见,单一或无典型临床症状的患者较多(分别占37.86%、13.27%);不同白细胞(WBC)水平患者血涂片镜检幼稚细胞检出率差异有统计学意义(P<0.01),随着WBC数量的增加,幼稚细胞检出率明显增加;不同临床症状AL患者外周血WBC计数及血涂片镜检幼稚细胞检出率差异有统计学意义(P>0.05)、血红蛋白(HGB)含量和血小板(PLT)计数差异有统计学意义(P<0.05)。结论:AL非特异性的临床表现增加;临床症状不典型的AL患者,其血常规指标变化亦不明显;WBC正常或降低的患者要加强显微镜形态学检查。

Objective:To provide a new basis for the diagnosis and treatment of acute leukemia(AL)by analyzing the clinical symptoms of first-diagnosed AL patients and the characteristics of peripheral blood changes.Methods:The clinical data,peripheral blood features and diagnostic classification on first-diagnosed AL patients were retrospectively analyzed,who were admitted and diagnosed by the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University from January 2014 to December 2018.Results:Most patients with AL had one or more typical clinical symptoms,of which anemia(53.07%)and hemorrhage(42.39%)were the most common,and more and more patients with only one or non-typical clinical symptoms(37.86%and 13.27%respectively).There was significant difference in the detection rate of blasts in blood smear microscopy between different white blood cell(WBC)levels(P<0.01).With the increase of WBC counts,the detection rate of blasts increased significantly.There were no significant differences in WBC counts and the detection rate of blasts between different clinical symptoms(P>0.05),but there was significant difference between hemoglobin(HGB)content and platelet(PLT)count(P<0.05).Conclusion:The non-specific clinical manifestations of AL are increased.Patients with atypical clinical symptoms,whose changes in blood routine examination are not obvious,should be highly alert to the possibility of AL.As patients with normal or reduced WBC are easily ignored,peripheral blood morphological examination should be strengthened.