急性白血病血小板输注疗效影响因素及其对临床预后的影响研究

Study on the influencing factors of platelet transfusion efficacy and its effect on prognosis of patients with acute leukemia

目的探索血小板输注疗效的影响因素,并分析输注疗效与急性白血病患者的临床预后的关系。方法回顾性分析2015年7月—2017年6月本院收治的92例急性白血病患者的临床资料,按照血小板输注疗效将患者分为有效组和无效组(出现2次或2次以上输注无效的患者纳入无效组)两组,有效组55例,无效组37例。统计血小板输注有效率,单因素分析、多因素分析输注疗效的影响因素,并对其进行预后分析。结果血小板输注有效率为65.11%;单因素分析显示,血小板输注疗效与脾大、感染、HLA抗体、HPA抗体及输注次数有关,差异有统计学意义(P<0.05);而与年龄、性别、抗生素使用及疾病分类无关,差异不具有统计学意义(P>0.05);多因素分析显示,感染、HLA抗体、HPA抗体及输注次数是影响急性白血病患者输注血小板疗效的高危因素(P<0.05)。血小板输注无效组患者的复发率(36.40%)明显高于有效组(16.90%),差异有统计学意义(P<0.05);无效组患者的死亡率(39.40%)高于有效组(24.50%),差异有统计意义(P<0.05);急性髓系白血病(AML)患者无效组的中位生存期为25.0个月,而有效组中位生存期未到达,差异有统计学意义(P<0.05);急性淋巴细胞白血病(ALL)患者有效组中位生存期21.0个月远高于无效组11.0个月,差异有统计学意义(P<0.05)。结论影响急性白血病患者输注血小板疗效的主要因素是感染、HLA抗体、HPA抗体及输注次数。血小板输注无效的急性白血病患者临床预后较差。

Objective To investigate the influence factors of platelet transfusion efficacy on patients with acute leukemia(AL)and the correlation between platelet transfusion efficacy and prognosis.Methods A total of92 patients with acute leukemia those were admitted to our hospital from July 2015 to June 2017 were enrolled in the study,according to the efficacy of platelet transfusion they were divided into effective group(n=55)and invalid group(ineffective platelet transfusion occurring for more than twice or equal to twice,the patients were enrolled in invalid group,n=37).The efficacy rate of platelet transfusion was calculated,univariate analysis and multivariate analysis were performed on the influencing factors of infusion efficacy,and the prognosis of the patients were analyzed.Results The effective rate of platelet transfusion was 65.1%.The univariate factor analysis revealed that,the platelet transfusion efficacy was relevant to splenomegaly,infection,anti-human leukocyte antigen antibody(HLA antibody),anti-human platelet antigen antibody(HPA antibody)and infusion times(P<0.05),while was irrelevant to genders,age,antibiotic use or the type of AL(P>0.05).Multivariate analysis revealed that infection,HLA antibody,HPA antibody and infusion times were the high risk factors of platelet transfusion efficacy in acute lymphoblastic leukemia(P<0.05).The recurrence rate of ineffective platelet infusion group(36.40%)was significantly higher than that of effective group(16.90%),with statistical significance(P<0.05).The mortality in invalid group(39.4%)was higher than that in efficient group(24.5%),which is statistically significant(P<0.05).Patients with acute myeloid leukemia in efficient groups was not reached the median survival time which was 25.0 months in the invalid group(P<0.05).Median survival time for patients with acute lymphoblastic leukemia(ALL)in effective group was 21.0 months,which was higher than 11.0 months in invalid group(P<0.05).Conclusions Infection,HLA antibody,HPA antibody and infusion times were the primary risk factors of platelet transfusion efficacy in acute lymphoblastic leukemia.AL patients who in the invalid group have a worse prognosis compared with the efficient group.