11例急性早幼粒细胞白血病患者并发维甲酸综合征的临床分析

Clinical Analysis of Retinoic Acid Syndrome Developed in 11 Pat ients with Acute Promyelocytic Leukemia

为了探讨急性早幼粒细胞白血病 (APL)并发的维甲酸综合征 (RAS)的临床特点、发病危险因素及治疗 ,对11例APL并发RAS病人的临床和实验室检查资料进行了回顾性分析。结果表明 :RAS较多见且较早出现 ,其临床症状为呼吸困难 (11/ 11)、发热 (10 / 11)和胸腔积液 (6/ 11)等。全反式维甲酸 (ATRA)治疗中白细胞数增高 (≥15 0× 10 9/L)者易发生RAS(9/ 11)。在继续应用ATRA的同时静脉滴注地塞米松治疗的有 10例缓解 ,1例死于弥散性血管内凝血。结论 :早期识别RAS症状和应用地塞米松治疗是取得较好临床效果的关键 。

To explore the clinical features, risk factors an d treatment of retinoic acid syndrome (RAS) in patients with acute promyelocytic leukemia (APL) treated with retinoic acid, the clinical and laboratory data of 11 APL pat ients with RAS were retrospectively analysed. The results showed that earlier an d more common symptoms of RAS were successively dyspnea (11/11), fever (10/11) a nd hydrothorax (6/11). Higher WBC count (≥15.0×10 9/L) in the course of tre atment of all-trans retinoic acid susceptible to develop RAS (9/11). The RAS patients were treated with dexamethasone without discontinuing the treatment of retinoic acid, complet e remission was achieved in 10 cases and one patient died from disseminated intr avascular coagulation. It is concluded that the identification and dexamethasone treatment of RAS in earlier period are extremely important for obtaining better clinical curative effect, and it does not influence therapeutic effect of conti nuing application of retinoic acid.