外周血白血病细胞绝对数与急性早幼粒细胞白血病早期严重出血事件相关性分析

Correlation of absolute number of peripheral blood leukemic cells with early severe bleeding in patients with acute promyelocytic leukemia

目的观察急性早幼粒细胞白血病(acute promyelocytic leukemia, APL)早期严重出血患者外周血白血病细胞绝对数变化,探讨外周血白血病细胞绝对数与APL早期严重出血的关系。方法 APL患者159例,均给予全反式维甲酸联合三氧化二砷诱导治疗,对治疗30 d内发生出血事件者,采用WHO出血评分量表评估出血严重程度,并将其分为严重出血组和非严重出血组。比较2组诱导治疗前白细胞计数、血小板计数、血红蛋白、外周血白血病细胞绝对数、骨髓早幼粒细胞百分比、凝血酶原时间、活化部分凝血活酶时间及纤维蛋白原、D-二聚体、乳酸脱氢酶、血肌酐水平;多因素logistic回归分析APL患者发生早期严重出血事件的影响因素。结果 159例APL患者,治疗30 d内133例发生不同程度的出血,其中严重出血组15例,非严重出血组118例。严重出血组白细胞计数[21.41(1.94,122.49)×10^(9)/L]、外周血白血病细胞绝对数[19.70(1.28,112.69)×10^(9)/L]、骨髓早幼粒细胞百分比[89.20(86.00,89.60)%]、乳酸脱氢酶水平[547.50(362.50,990.25)u/L]均高于非严重出血组[6.50(1.76,22.58)×10^(9)/L、2.51(0.28,13.93)×10^(9)/L、83.20(77.90,88.00)%、326.00(232.00,562.50)u/L](P<0.05),凝血酶原时间[17.70(13.10,19.40)s]长于非严重出血组[15.00(12.98,17.20)s](P<0.05);2组血小板计数、血红蛋白、活化部分凝血活酶时间、纤维蛋白原、D-二聚体及血肌酐水平比较差异均无统计学意义(P>0.05)。外周血白血病细胞绝对数(OR=1.028,95%CI:1.009~1.047,P=0.004)是APL患者发生严重出血事件的独立影响因素。结论早期严重出血的APL患者外周血白血病细胞绝对数升高,外周血白血病细胞绝对数是APL患者发生早期严重出血事件的独立影响因素。

Objective To observe the changes of the absolute number of peripheral blood leukemia cells in acute promyelocytic leukemia(APL) patients with early severe bleeding, and to investigate the relationship between the absolute number of peripheral blood leukemia cells and early severe bleeding in APL patients. Methods All 159 patients with APL received all-trans retinoic acid + arsenic trioxide induction therapy. Those with bleeding within 30 d of therapy were divided into severe bleeding group and non-severe bleeding group according to the bleeding severity by WHO Bleeding Scale. The white blood cell count, platelet count, hemoglobin, absolute number of peripheral blood leukemic cells, percentage of bone marrow promyelocytes, prothrombin time, activated partial thromboplastin time, and the levels of fibrinogen, D-dimer, lactate dehydrogenase and creatinine were compared before therapy between two groups. Multivariate logistic regression was used to analyze the influencing factors of early severe bleeding in APL patients. Results In 159 APL patients, bleeding in different degrees occurred in 133 patients within 30 d of therapy, in which there were 15 patients with severe bleeding(severe bleeding group) and 118 patients without severe bleeding(non-severe bleeding group). The white blood cell count(21.41(1.94, 122.49)×10^(9)/L), absolute number of peripheral blood leukemic cells(19.70(1.28, 112.69)×10^(9)/L), bone marrow promyelocytes percentage(89.20(86.00, 89.60)%), and lactate dehydrogenase level(547.50(362.50,990.25)u/L)in severe bleeding group were higher than those in non-severe bleeding group(6.50(1.76,22.58)×10^(9)/L,2.51(0.28,13.93)×10^(9)/L,83.20(77.90,88.00)%,326.00(232.00,562.50)u/L)(P<0.05). The prothrombin time was longer in severe bleeding group(17.70(13.10,19.40)s)than that in non-severe bleeding group(15.00(12.98,17.20)s)(P<0.05).There were no significant differences in platelet count,hemoglobin,activated partial thromboplastin time,fibrinogen,D-dimer and creatinine levels between two groups(P>0.05).The absolute number of peripheral blood leukemic cells(OR=1.028,95%CI:1.009-1.047,P=0.004)was an independent influencing factor of severe bleeding in patients with APL.Conclusion The absolute number of peripheral blood leukemic cells is elevated in APL patients with early severe bleeding,and is an independent influencing factor of early severe bleeding in APL patients.