急性早幼粒细胞白血病出血机制

<正>急性早幼粒细胞白血病(APL)由于伴有严重的凝血功能障碍,常常引发致命性出血,早期死亡率极高,尤其见于APL患者化疗后骨髓抑制期。出血以不同形式发生于不同部位。研究〔1〕对APL患者接受全反式维甲酸(ATRA)和伊达比星治疗期间发生致命性出血部位的统计发现,颅内出血是出血性死亡最主要原因,并且致命性出血通常发生在诱导治疗的早期。APL患者并发出血,与APL病期与患者年龄有一定的相关性,     

急性白血病并发出血患者的止凝血特点及其与预后的关系

目的：研究急性白血病(AL)并发不同程度出血患者的止凝血异常特点及其与预后的关系。方法：采用ELISA方法检测93例AL患者血浆组织因子(TF)、组织因子途径抑制物(TFPI)、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-抗纤溶酶复合物(PAP)、尿激酶型纤溶酶原激活物(u-PA)、尿激酶型纤溶酶原激活物受体(u-PAR)、D-二聚体(D-D)的含量。结果：仅有TF、TAT、D-D升高者，临床上大多表现为轻度出血；除TF、TAT、D-D显著升高外，还伴有u-PA、u-PAR、PAP高于无出血对照组者，临床上以重度出血为主。TAT、PAP、D-D对弥散性血管内凝血前期(pre—DIC)诊断的灵敏度分别为88．57％、97．14％和85．70％，特异性为69．57％、76．09％和89．13％；联合应用三个指标，其灵敏度为80．OO％，特异性为95．65％。u-PA、u-PAR持续增高者预后差，2年无复发生存率(RFS)和2年总生存率(OS)显著降低。结论：轻度出血主要由高凝、继发性纤溶亢进等引起，而原发性纤溶亢进则是重度出血最主要的原因；TAT、PAP、D-D对pre—DIC的诊断有重要意义；多项分子标志物的联合应用可提高pre—DIC的确诊率。TF对DIC的发展和进程具有预示作用。u-PA、u-PAR可作为部分AL并发出血患者的预后判断指标。     

急性白血病患者医院感染危险因素分析

目的探讨急性白血病患者医院感染的特点及危险因素,为防治医院感染提供依据。方法回顾性分析246例急性白血病医院感染患者的临床资料,采用单因素,及多因素非条件Loglstic进行相关危险因素分析。结果急性白血病患者医院感染发病率为57．7％;最容易发生感染的部位为呼吸道、口腔及血液;病原茵以G-感染占首位;多因素分析显示预防性使用抗生素、肛周疾患、肺部疾患、糖尿病及长时间糖皮质激素的使用是独立的医院感染危险因素;较高的血红蛋白及血小板水平是医院感染的保护性因素。结论临床针对上述独立危险因素采取积极的预防措施有助于控制急性白血病患者的医院感染率。     

急性脑血管病患者脑微出血发生率及其危险因素

目的探讨脑微出血在急性脑血管病患者中的发生率及其危险因素。方法 90例急性脑血管病患者分为脑微出血组(46例)和无脑微出血组(44例),记录所有患者的临床资料并行磁共振成像(MRI)检查,采用单因素和多因素Logistic回归分析危险因素。结果 90例急性脑血管病患者发生脑微出血46例中,脑出血27例,发生脑微出血19例;脑梗死51例,发生脑微出血26例;短暂性脑缺血发作12例,发生脑微出血1例。多因素Logistic回归分析显示,脑微出血的独立危险因素为高血压(OR=8.853,95%CI=1.712~45.803,P=0.009)、入院收缩压(OR=1.716,95%CI=1.206~2.441,P=0.003)、腔隙性脑梗死分级(OR=7.745,95%CI=2.645~22.672,P=0.000)。结论脑出血、脑梗死患者脑微出血的发生率较高,脑微出血的独立危险因素为高血压、入院收缩压、腔隙性脑梗死分级。     

急性白血病院内感染危险因素分析及防治

院内感染是急性白血病化疗的常见并发症 ,也是引起死亡的重要原因之一[1] 。我们对 1 997～ 2 0 0 0年收治的 1 60例急性白血病住院患者进行了回顾性调查 ,以期对院内感染的危险因素进行分析 ,并探讨其合理的防护对策。1　资料与方法本组男 87例、女 73例 ,年龄 1 4～ 62岁。其中急性髓性白血病 96例 ,急性淋巴细胞白血病 62例 ,慢粒急变 2例 ,均经血象、骨髓象或细胞化学等检查确诊。根据血、尿、粪便、痰液等常规及 B超、X线等检查 ,结合病原学检查确定有无感染及感染部位 ,采用统一表格形式调查院内感染者抗生素、激素、化疗方案的使用…     

儿童急性白血病环境危险因素研究

目的 探讨潜在环境危险因素与儿童急性白血病发病的关系.方法 以2014-04～2020-08在广州市妇女儿童医疗中心就诊的532例初发急性白血病患儿为病例组,选取广州市妇女儿童医疗中心儿内科及儿外科门诊就诊的500例非肿瘤、非遗传性免疫/内分泌疾病患儿作为对照组,进行病例对照研究.通过问卷调查的方式记录两组儿童及其父母...     

急性白血病生存期有关因素的分析

本文对36例急性白血病患者之治疗、随访观察,探讨了急性白血病预后有关的因素。认为白细胞数高于50×10~9/L,CNS、皮肤、消化道等多处浸润,均提示预后不良。病情达 CR后,强而有力的长期巩固强化治疗,定期鞘内注射的治疗,患者也有望得以长期存活.     

以下消化道出血为首发症状的急性巨核细胞白血病1例

患者,女,34岁,9 d前无明显诱因出现黏液血便,发热寒战,伴腹胀腹痛入院.纤维结肠镜检查未见异常.经血常规、骨髓像、免疫组化及流式细胞术检测单个核细胞的免疫表型CD41确诊为急性巨核细胞白血病.此病例以下消化道出血为首发症状,易误诊误治,临床极少见.     

高白细胞急性白血病50例分析

目的　研究高白细胞急性白血病 (HAL )的临床特点。方法　对 5 0例 HAL进行临床回顾性分析 ,同时选择 5 0例非高白细胞急性白血病 (HAL )作对照组。结果　 HAL起病急骤、病程<1月 ,脏器出血、髓外浸润的发生率、白细胞瘀滞综合征及化疗后肿瘤溶解综合征、早期死亡率较对照组高。结论　对 HAL降低血液粘滞度、化疗前、化疗中硷化尿液及水化治疗 ,以降低早期死亡率     

Development of acute myelocytic leukemia in patients with Crohn's disease

Summary In our hospital within one year two patients with Crohn's disease were seen who developed an acute myelocytic leukemia. A review of the literature reveals eight previously reported patients with both Crohn's disease and leukemia. Six of the reported 10 patients have had acute myelocytic leukemia and, interestingly, three of them, including our two patients, have shown monocytic differentiation (FAB type M4). It has been suggested that the relative risk of leukemia, especially acute myelocytic leukemia, is increased in patients suffering from ulcerative colitis. More data of patients with Crohn's disease and acute leukemia are needed to evaluate the possible association between these diseases.     

Severe hemorrhagic complications during remission induction therapy for acute promyelocytic leukemia: incidence, risk factors, and influence on outcome

BACKGROUND: Even after the introduction of all-trans retinoic acid (ATRA), early hemorrhagic death remains a major cause of remission induction failure for acute promyelocytic leukemia (APL). METHODS: To investigate severe hemorrhagic complications during remission induction therapy with respect to incidence, risk factors, and influence on outcome. Results were analyzed for 279 patients enrolled in the APL97 study conducted by the Japan Adult Leukemia Study Group (JALSG). RESULTS: Severe hemorrhage occurred in 18 patients (6.5%). Although most of them were receiving frequent transfusions, the targeted levels of platelet counts (30 x 10(9)/L) and plasma fibrinogen (1.5 g/L) for this study were reached at the day of bleeding in only 71% and 40%, respectively. Nine of them succumbed to an early death, while the remaining nine patients eventually achieved complete remission (CR). The 5-yr event-free survival rate was 68.1% for those who did not suffer severe hemorrhage, and 31.1% for those who did (P < 0.0001). For patients who achieved CR, on the other hand, there was no difference in disease-free survival between patients with and without severe hemorrhage (P = 0.6043). Risk factor analysis identified three pretreatment variables associated with severe hemorrhage: initial fibrinogen level, white blood cell count, and performance status. Additionally, patients with severe hemorrhage were more easily prone to develop retinoic acid syndrome or pneumonia than patients without hemorrhage. CONCLUSIONS: These results indicate that fatal hemorrhage represents a major obstacle in curing APL, and that patients with such high-risk features may benefit from more aggressive supportive care.     

Clinical utility of marrow cell tissue cultures in acute leukemia of childhood

To determine the clinical value of tissue culture techniques in the study of acute leukemia, marrows from 50 children (40 acute lymphoblastic [ALL], 10 acute myeloblastic [AML]) were cultured by the use of an AML blast colony assay and the CFU-GEMM assay. In the AML assay, AML marrow gave rise to high numbers of blast colonies within 24 to 48 hr; in sharp contrast, 37 of 40 ALL marrows did not yield colonies in this assay. In the CFU-GEMM assay, AML marrow produced excessive numbers of monocyte-macrophage CFU-C colonies, an obvious background of individual macrophages and clusters, and occasional blast colonies. ALL marrow yielded very low numbers of granulocytic CFU-C colonies, no background of macrophage cells, and no blast colonies. These clear-cut differences in cellular growth kinetics in vitro between ALL and AML marrows should allow confirmation of the type of acute leukemia within 24 to 48 hr. The colony assays may also be valuable in differentiating ALL from AML in difficult diagnoses when conventional approaches are nondiagnostic.     

急性淋巴细胞白血病患儿肝功能损害相关因素分析及治疗

目的分析急性淋巴细胞白血病（ALL）患儿肝功能损害原因,指导临床治疗。方法对124例ALL患儿于化疗不同阶段进行肝功能和病毒学检测,对引起肝功能损伤的原因、损害程度及保肝治疗效果进行分析。结果124例患儿中58例发生肝功能损害,其中药物性损害发生率（70．69％）明显高于病毒性及白血病浸润性损害,以病毒性损害程度最重,以大剂量甲氨喋呤（HDMTX）庇护所防治期最常见;经复方甘草酸单胺、还原性谷胱甘肽及相应抗病毒治疗后,各组谷草转氨酶和谷丙转氨酶均恢复正常,病毒性损害恢复时间最长。结论针对ALL肝损害病因进行治疗可促进肝功能恢复,利于化疗顺利进行。     

Circulating endothelial cells in patients with acute myeloid leukemia

OBJECTIVES: The circulating endothelial cells (CEC) are proposed to be a non-invasive marker of angiogenesis. The level of CEC in peripheral blood (PB) of acute myeloid leukemia (AML) patients has not been investigated prior to this study. We evaluated the count of resting (rCEC), activated (aCEC) and endothelial progenitor cells (CEPC) in the PB of AML and healthy subjects. In addition we correlated the levels of CEC with disease status, known prognostic factors and response to treatment. METHODS: CEC were quantified by utilizing four-color flow cytometry procedures in 48 AML patients at the time of diagnosis and 29 healthy controls. Additionally, measurements were again taken after the first course of induction treatment in 12 of the patients. RESULTS: The numbers of aCEC, rCEC and CEPC were significantly higher in the AML patients than in the controls (P < 0.0001, P < 0.0001 and P < 0.001, respectively). The CEC count was significantly higher in the AML patients with white blood cell count (WBC) >15 G/L, elevated lactic dehydrogenase (LDH) levels and a higher (over median) absolute blasts count (ABC) in PB than in the group with WBC <15 G/L (P < 0.03), a normal LDH level (P < 0.03) and a lower (相似文献   

Clinical characteristics,prognostic factors and multidrug-resistance related protein expression in 36 adult patients with acute promyelocytic leukemia

We report on a single-center experience about the characteristics and outcome of 36 acute promyelocytic leukemia (APL) patients observed at our Department of Hematology between 1990 and 2002. The expression, of multidrug-resistance (MDR) associated proteins (PGP, LRP, MRP1) was also analyzed. There were 12 males and 24 females (median age 37 yr), 89% (32 of 36) with classic morphology, and 11% (four of 36) with a microgranular variant. Risk class (according to GIMEMA/PETHEMA): 25% (nine of 36) high risk (HR), 53% (nineteen of 36) intermediate risk (IR), 22% (eight of 36) low risk (LR). PGP, LRP, and MRP1 expression at onset and at first relapse was low. CD33 antigen expression was high in all cases. The patients were treated according to GIMEMA protocols (LAP0389 and AIDA) including ATRA in induction in 75% (27 of 36) of cases and 94% (34 of 36) achieved a complete remission (CR) after induction therapy while 6% (two of 36) died early (DDI) of hemorrhage. Outcome: 71% (24 of 34) of evaluable patients remain in CR at a median follow-up of 57 months (range 4-158 months) while 29% (10 of 34) relapsed at a median time of 12 months (range 8-43 months) and, of them, eight of 10 died early. The majority of patients that relapsed were in high-risk group. The overall survival (OS) of the whole population at 32 months was 66% and the DFS at 42 months was 62%. A statistically significant difference in terms of DFS was observed between HR and IR/LR patients (P = 0.04 by log-rank). DFS was not affected by age, sex, Hb levels, karyotype, and BCR isoform. At conclusion, our data confirm that despite the high rate of success with ATRA plus chemotherapy as induction (more than 90% of CR), about 30% of APL patients have a relapse (without a long-lasting second remission) and underline the importance of patient stratification in distinct risk groups at diagnosis in order to better adapt the type and intensity of treatment (risk-adapted therapy). Taking into account the high expression of CD33 and the low expression of MDR proteins in APL, new and investigational approaches like gemtuzumab-ozogamicin, with or without ATRA and other new drugs, should be strongly considered expecially in HR APL.     

Outcomes and charges of elderly patients with acute myeloid leukemia

A retrospective database analysis was conducted to evaluate hospitalization outcomes and charges among elderly acute myeloid leukemia (AML) patients. The data source was a longitudinal (2000-2003) inpatient database from 28 US hospitals. Data on 275 AML patients aged 60 and older were analyzed for demographic and treatment characteristics, hospital mortality, length of stay (LOS), overall days of stay (DOS), and charges across multiple admissions. Multivariate modeling was performed to determine factors that influenced outcomes. Overall, 115 (41.8%) patients received inpatient chemotherapy (CT); most (90.4%) received it on the first admission. Of all initial CT regimens 40.9% consisted of a single agent. The mean LOS for initial hospitalization was 23.0 (SD 21.8) days for patients who received CT and 6.7 (SD 7.5) days for those who did not. One quarter (25.3%) of initial hospitalizations resulted in death. On initial hospitalization, mean total charges were $113,118 (SD $220,417) for patients who received CT and $43,999 (SD $190,533) for those who did not; for both groups mean charges were higher than respective subsequent admission charges. Overall, in-hospital mortality did not differ significantly between on-CT and off-CT groups (43.5 and 38.8%, respectively). In multivariate modeling, CT was significantly associated (P < 0.0001) with increased charges and LOS. Elderly patients with AML incurred substantial hospital charges and inpatient mortality. The highest charges and a substantial number of deaths occurred during first admission. Although treatment with CT was associated with increased charges and days in-hospital, inpatient mortality in the two groups was found to be similar.     

High-dose cytosine arabinoside and mitoxantrone in previously-treated acute leukemia patients

35 patients with refractory or relapsed acute leukemia received salvage chemotherapy using high-dose cytosine arabinoside 2 g/m2 intravenously for 3 hours every 12 h, in 8 doses, followed by continuous infusion of mitoxantrone 12 mg/m2/day for 2 d. 9 patients had acute myeloblastic leukemia (AML), (4 relapsed, 5 refractory), 20 had acute lymphoblastic leukemia (ALL) (11 relapsed, 9 refractory) and 6 had chronic myelogenous leukemia (CML) in the blastic phase (BP). 4 out of 9 AML and 16 out of 20 ALL achieved complete remission. Median survival was 6 months for all patients and 10 months for responders. A short (1.5 months) chronic phase was achieved in 3 patients with CML. The main toxic effect was hematologic. A pharmacokinetic study was performed on mitoxantrone. No correlation was found with clinical response. The combination of mitoxantrone and ara-C is an effective antileukemic regimen, especially in ALL.