血液系统恶性肿瘤并发肿瘤溶解综合征的临床特征和影响因素

Clinical characteristic and risk factors of hematological malignancies with tumor lysis syndrome

目的探讨血液系统恶性肿瘤患者并发肿瘤溶解综合征(TLS)的发生率、临床特点及危险因素。方法回顾性分析2019年1月至2021年6月福建省立医院血液科收治的182例血液系统恶性肿瘤患者的临床资料,分析患者TLS的发生情况及其危险因素。结果182例患者中,28例患者并发TLS,发生率15.4%。并发TSL患者均出现血尿酸升高,血乳酸脱氢酶升高25例(89.3%),高磷血症21例(75.0%),低钙血症16例(57.1%),尿素氮和肌酐升高9例(32.1%),高钾血症7例(25.0%)。单因素分析显示,年龄、白细胞计数、肿块直径、肌酐、尿酸、血清乳酸脱氢酶与并发TLS相关(P<0.05)。多因素logistic分析显示,白细胞计数≥50×10^(9)/L(β=1.260,OR=3.500,P=0.012,95%CI:1.862~7.144)、肿块直径≥5 cm(β=0.094,OR=1.986,P=0.028,95%CI:1.357~6.553)、肌酐≥123μmol/L(β=1.370,OR=3.742,P=0.011,95%CI:1.195~5.832)、尿酸≥476μmol/L(β=0.071,OR=1.934,P=0.036,95%CI:1.580~4.748)、乳酸脱氢酶≥245 U/L(β=2.890,OR=6.843,P=0.009,95%CI:1.468~8.748)为独立危险因素。结论TLS是血液系统恶性肿瘤的常见严重并发症,治疗中应密切监测,警惕其危险因素,及时干预是非常必要的。

Objective To explore the incidence,clinical characteristics and risk factors of patients with tumor lysis syndrome(TLS)in patients with hematological malignancies.Methods The clinical data of 182 patients with hematological malignancies admitted to the Department of Hematology,Fujian Provincial Hospital from January 2019 to June 2021 were retrospectively analyzed,and the occurrence and risk factors of TLS were analyzed.Results Among 182 patients,28 patients were complicated with TLS,with an incidence of 15.4%.All patients with TSL had elevated serum uric acid,elevated serum lactate dehydrogenase(LDH)in 25 cases(89.3%),hyperphosphatemia in 21 cases(75.0%),hypocalcemia in 16 cases(57.1%),elevated urea nitrogen and creatinine in 9 cases(32.1%),and hyperkalemia in 7 cases(25.0%).Univariate analysis showed that age,white blood cell count,mass diameter,creatinine,uric acid and serum lactate dehydrogenase were associated with TLS(P<0.05).Multivariate logistic analysis showed that white blood cell count≥50×10^(9)/L(β=1.260,OR=3.500,P=0.012,95%CI:1.862-7.144)and mass diameter≥5 cm(β=0.094,OR=1.986,P=0.028,95%CI:1.357-6.553),creatinine≥123μmol/L(β=1.370,OR=3.742,P=0.011,95%CI:1.195-5.832),uric acid≥476μmol/L(β=0.071,OR=1.934,P=0.036,95%CI:1.580-4.748)and lactate dehydrogenase≥245 U/L(β=2.890,OR=6.843,P=0.009,95%CI:1.468-8.748)were independent risk factors.Conclusion TLS is a common and serious complication of hematological malignancies.It is necessary to closely monitor and guard against its risk factors during treatment.