摘要
回顾6例以栓塞为首发临床表现的成人急性早幼粒细胞白血病(APL)患者的临床资料。其中男性5例,女性1例,中位年龄55岁,均有心血管病危险因素和2系以上血细胞异常,5例合并弥散性血管内凝血。低危组3例(均为bcr1亚型),中危组1例(bcr2亚型),高危组2例(1例bcr3亚型,1例不详)。3例检测FLT3-ITD突变,结果为阴性。6例血栓栓塞,以脑梗死最常见(4例),1例为下肢动脉栓塞,1例为多部位动静脉血栓。4例合并脑梗死患者在对症治疗同时给予全反式维甲酸(ATRA)联合三氧化二砷(ATO)、化疗(高危组患者未应用ATRA),2例达完全缓解后遗言语不流利,另2例分别死于继发脑出血及脑梗死。下肢动脉血栓患者入院12 h内猝死,可能为急性心肌梗死。多部位血栓患者行下腔静脉滤器置入术后,应用低分子肝素钙、利伐沙班抗凝治疗,经ATRA+ATO诱导治疗达完全缓解。提示动静脉栓塞为APL的不典型临床表现,当发现栓塞患者伴有血细胞和/或凝血异常时,需注意排除APL的可能,APL伴栓塞患者合并弥散性血管内凝血概率高、治疗难度大,高危组患者预后差。
The clinical data of 6 acute promyelocytic leukemia(APL)patients with thrombosis as the first manifestation were retrospectively analyzed.Among 6 patients,5 were males and 1 female.The median age at diagnosis was 55 years old.All patients had risk factors for cardiovascular disease(CVD),and 5 patients met the diagnostic criteria for disseminated intravascular coagulation(DIC).There were 3 patients at low risk(bcr1 subtype),1 at intermediate risk(bcr2 subtype)and 2 at high risk(1 bcr3 subtype and 1 unknown).FLT3-ITD mutations were tested in 3 cases,all of whom showed negative results.Arterial thrombosis was found in all 6 cases,4 cases had cerebral infarction,1 had lower limb arterial embolism,and 1 had multiple arterial and venous thrombosis.Four patients with cerebral infarction received all-trans retinoic acid(ATRA)combined with arsenic trioxide(ATO)±chemotherapy and symptomatic treatment(1 patient at high risk did not receive ATRA),2 patients achieved complete remission(CR),and the other 2 patients died of cerebral hemorrhage and cerebral infarction,respectively.One patient with lower extremity arterial thrombosis died suddenly within 12 h after admission likely due to acute myocardial infarction.One patient with mixed thrombosis received low molecular weight heparin and rivaroxaban successively after inferior vena cava filter implantation,and achieved CR after ATRA+ATO treatment.Thrombosis is a less common and under-recognized presentation in APL.Thrombosis patients with blood cells and/or coagulation abnormalities should consider the possibility of APL.APL patients complicated with thrombosis have a high probability of DIC and remain mostly intractable to existing treatments,who are at high risk of death and poor prognosis.
作者
郝李霞
任娟
张建华
马艳萍
杨林花
Hao Lixia;Ren Juan;Zhang Jianhua;Ma Yanping;Yang Linhua(Department of Hematology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《中华全科医师杂志》
2023年第1期74-77,共4页
Chinese Journal of General Practitioners
关键词
白血病
早幼粒细胞
急性
血栓栓塞
临床特征
预后
Leukemia,promyelocytic,acute
Thromboembolism
Clinical features
Prognosis
