Page 60 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第42卷第10期
·1402 · Journal of Nanjing Medical University（Natural Sciences） 2022年10月

·临床研究·

急性早幼粒细胞白血病的并发症及其危险因素分析

杜 粤 ，王 翔 ，陆彬彬 ，缪扣荣 ，陆 超 1*
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南京医科大学第一附属医院儿科，血液科，江苏 南京 210029
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［摘 要］ 目的：总结儿童及青少年急性早幼粒细胞白血病诊治中的主要并发症，分析其发生的危险因素。方法：回顾性分析
2010年1月—2021年5月南京医科大学第一附属医院收治的43例初诊急性早幼粒细胞白血病儿童及青少年病例，总结分析各
类并发症的发病率，根据分化综合征临床诊断标准分为分化综合征组和非分化综合征组，采用多因素 Logistic回归分析分化
综合征发生的危险因素，采用Kaplan⁃Meier生存分析评估患者的累积无事件生存率和总生存期。结果：43例急性早幼粒细胞白血
病患者中，与非分化综合征组比较，分化综合征组的维甲酸诱导后血清铁蛋白、乳酸脱氢酶（lactate dehydrogenase，LDH）、白细
胞介素 6（interleukin⁃6，IL⁃6）、白蛋白都高于非分化综合征组，差异有统计学意义（P < 0.01）。多因素 Logistic 逐步回归分析显
示，外周血白细胞数（white blood cell，WBC）最高值（WBCmax ）、血清铁蛋白、LDH和IL⁃6显著升高是诱导治疗期间发生分化综合
征的独立危险因素（P < 0.01）。高危组和低危组累积总生存率和无事件生存率相比，差异无统计学意义。结论：儿童及青少年
急性早幼粒细胞白血病诊治过程中可出现出血和分化综合征等多种并发症。维甲酸诱导治疗后的WBC、LDH、血清铁蛋白和
IL⁃6 等炎症因子过度升高是发生分化综合征的危险因素。
［关键词］ 白血病；早幼粒细胞；急性；并发症；分化综合征；危险因素
［中图分类号］ R733.71 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）10⁃1402⁃07
doi：10.7655/NYDXBNS20221008

Analysis of complications and their risk factors of acute promyelocytic leukemia

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DU Yue ，WANG Xiang ，LU Binbin ，MIAO Kourong ，LU Chao 1*
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1 Department of Pediatrics，Department of Hematology，the First Affiliated Hospital of Nanjing Medical University，
Nanjing 210029，China
［Abstract］ Objective：To summarize the major complications of acute promyelocytic leukemia in children and adolescents and to
analyze the risk factors. Methods：Retrospective analysis was performed for children and adolescents with primary acute promyelocytic
leukemia admitted to the First Affiliated Hospital of Nanjing Medical University from January 2010 to May 2021. The incidences of
various complications were summarized. The risk factors for the occurrence of differentiation syndrome was evaluated with logistic multi⁃
variate regression. Kaplan⁃Meier survival analysis was used to assesse the cumulative event⁃free survival（EFS）and overall survival
（OS）of the patients. Results：In 43 patients with acute promyelocytic leukemia，the levels of serum ferritin，lactate dehydrogenase
（LDH），interleukin⁃6（IL⁃6）and albumin（ALB）in the differentiation syndrome group were significantly higher than those in the
non⁃differentiation syndrome group（P < 0.05）. Multivariate logistic stepwise regression analysis showed that WBC max，serum ferritin，
LDH and IL⁃6 were significantly increased，which were independent risk factors for differentiation syndrome during induction treatment
（P < 0.01）. There was no significant difference in cumulative OS rate and EFS rate between high ⁃ risk group and low ⁃ risk group.
Conclusion：Various complications including bleeding and differentiation syndrome may be observed during the initial period and
duration of therapy for acute promyelocytic leukemia in children and adolescents. Excessive increases of leukocyte count and
inflammatory factors such as LDH，serum ferritin and IL⁃6 after retinoic acid induction therapy are the risk factors for the occurrence of
differentiation syndrome.
［Key words］ leukemia；promyelocyte；acute；complication；differentiation syndrome；risk factor
［J Nanjing Med Univ，2022，42（10）：1402⁃1408］

［基金项目］ 国家自然科学基金（81770162）
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通信作者（Corresponding author），E⁃mail：luchaodoctor@163.com