急性早幼粒细胞白血病早期死亡相关因素分析

Analysis of relevent factors of early death in acute promyelocytic leukemia

目的探讨与初诊急性早幼粒细胞白血病(APL)患者早期死亡相关的危险因素。方法回顾性分析2008年10月至2022年6月安徽医科大学第二附属医院血液科诊治的84例初诊APL患者的基本情况、实验室常规检查、骨髓检查等临床病历资料,定量数据通过受试者工作特征曲线(ROC曲线)获取的截断值进行分层,采用logistic逐步回归分析法探讨影响初诊APL患者早期死亡的临床高危因素。结果早期死亡组预后分层均低于非早期死亡组,差异均有统计学意义(χ^(2)=5.23,P=0.022)。早期死亡组凝血酶原时间长于非早期死亡组,差异有统计学意义(Z=-2.22,P=0.026)。早期死亡组患者早幼粒细胞百分比高于非早期死亡组,差异有统计学意义(Z=-3.00,P=0.003)。根据ROC曲线以86.5%为临界值进行分层,2组比较差异有统计学意义(χ^(2)=10.61,P=0.001)。结论发病年龄大于或等于64.5岁、外周血涂片早幼粒细胞百分数大于或等于86.5%是初诊APL早期死亡的独立危险因素。

Objective To explore the risk factors associated with early death in newly diagnosed acute promyelocytic leukemia(APL).Methods The basic information,routine laboratory examination,bone marrow examination and other clinical medical records of 84 newly diagnosed APL patients in the Department of Hematology of the Second Hospital of Anhui Medical University from October 2008 to June 2022 were retrospectively analyzed.The quantitative data were stratified by the truncated value obtained by the receiver operating characteristic(ROC)curve.Logistic stepwise regression analysis was used to explore the high risk clinical factors affecting the early death of newly diagnosed APL patients.Results The prognosis stratification of the early death group was lower than that of the non-early death group,and the difference was statistically significant(χ^(2)=5.23,P=0.022).The prothrombin time in the early death group was longer than that in the non-early death group,and the difference was statistically significant(Z=-2.22,P=0.026).The percentage of promyelocytes in the early death groups was higher than that in the non early group,with a statistically significant difference(Z=-3.00,P=0.003)According to the ROC curve,86.5%was taken as the critical value,and the difference between the two groups was statistically significant(χ^(2)=10.61,P=0.001).Conclusion The age of onset≥64.5 years old and the percentage of promyelocytic granulocyte in peripheral blood smear≥86.5%are independent risk factors for early death of newly diagnosed APL.