摘要
目的通过对12例早期死亡的儿童急性白血病患儿进行回顾性分析,探讨儿童急性白血病早期死亡的高危因素及临床特征,为儿童白血病的临床治疗提供可借鉴的经验。方法对2008年4月至2013年2月初诊为白血病、尚未进行化疗而早期死亡的12例儿童急性白血病患儿应用相关因素回归分析的方法,从临床症状,体征,实验室检查,骨髓细胞形态学、免疫学、细胞遗传学和分子学(MICM)分型,并发症及死亡原因等方面进行回顾性分析。结果 12例患儿发生早期死亡的主要原因为颅内出血和多脏器功能衰竭。12例患儿中6例(50.0%)伴有高白细胞血症,8例(66.7%)伴感染,8例(66.7%)有不同部位出血,8例(66.7%)有明显脾淋巴结肿大,9例(75.0%)血小板计数小于100×109L-1,9例(75.0%)血红蛋白低于110 g/L,12例(100.0%)肝功能损害,3例(25.0%)肾功能损害,12例(100.0%)凝血功能异常。8例完成MICM分型,其中急性淋巴细胞型白血病6例、急性早幼粒细胞型白血病1例、慢性粒细胞型白血病1例。死亡原因:6例患儿死于颅内出血引发的脑疝,5例死于呼吸循环衰竭,1例死于肺出血。在伴高白细胞血症组以上异常的发生率明显高于非高白细胞血症组,差异有统计学意义(P<0.05)。结论儿童急性白血病早期死亡与高白细胞血症、感染、出血密切相关,而且这些因素也可以导致和加重多器官功能衰竭、颅内出血及脑疝的发生。因此,针对这些高危因素进行积极有效的防治,可为进一步化疗提供机会,有望改善患儿预后。
Objective Based on the retrospective analysis of 12 cases of early deaths in children with acute leukemia,to probe the high risk factors and clinical characteristics of early death in children with acute leukemia in order to provide reference for clinical treatment of childhood leukemia. Methods 12 cases of early deaths in children with acute leukemia, who were newly diagnosed from April 2008 to February 2013 without chemotherapy ,were analyzed retrospectively by regression analysis with relat- ed factors,including clinical symptoms, signs,laboratory examination, bone marrow morphology classification,immunophenotyp ing,cytogenetics classification,moleculues classification（MICM classification） and causes of death. Results The main reasons of early death among 12 children were intracranial hemorrhage and multiple organ failure： Among the 12 children with early death,6 cases （50.0%） were with hyperleukocytosis; 8 cases （66.7%） were with infection ; 8 cases （66.7%） had bleeding in different parts; 8 cases （66.7%） had obvious splenomegaly;blood platelet count in 9 cases （75.0%） was less than 100xl09 L-1;hemoglobin in 9 cases was under 110 g/L; 12 cases（100.0%） were with liver damage;3 cases（25.0%） were with renal damage and 12 cases（100.0%） were with abnormal coagulation. MICM classification was completed among 8 cases, 6 cases of which were acute lymphoblastic leukemia ; 1 case was acute promyelocytic leukemia and 1 case was chronic myeloid leukemia. 6 patients died of cerebral hernia caused by intracranial hemorrhage, 5 cases died of respiratory failure and the other 1 case died of pulmonary hemorrhage. The in- cidence of abnormal in hyperleukocytosis group was significantly higher than that in group without hyperleukocytosis,and the dif- ference had statistical significance （P〈0.05）. Conclusion The early death of children with with acute leukemia is closely related with hyperleukocytosis, infection and hemorrhage, meanwhile these factors can also cause and aggravate the o
出处
《现代医药卫生》
2013年第18期2725-2727,2730,共4页
Journal of Modern Medicine & Health
关键词
白血病
急性病
儿童
死亡原因
颅内出血
多器官功能衰竭
白细胞增多
早期死亡
Leukemia
Acute disease
Child
Cause of death
Intracranial hemorrhages
Multiple organ fail-ure
Leukocytosis
Early death
