| 许京菁,周 谋,高 飏,李少文,朱展鸿,李艳辉,何宗忠,杜红延.急性髓系白血病患者血小板输注疗效不佳及短期死亡的危险因素分析[J].,2023,(17):3310-3315 |
| 急性髓系白血病患者血小板输注疗效不佳及短期死亡的危险因素分析 |
| Analysis of Risk Factors for Poor Efficacy of Platelet Transfusion and Short-Term Death in Patients with Acute Myeloid Leukemia |
| 投稿时间：2023-02-09 修订日期：2023-02-28 |
| DOI：10.13241/j.cnki.pmb.2023.17.021 |
| 中文关键词: 血小板输注 急性髓系白血病 疗效 短期死亡 危险因素 |
| 英文关键词: Acute myeloid leukemia Platelet transfusion Efficacy Short-term death Risk factors |
| 基金项目:广东省医学科学技术研究基金（A2020217） |
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| 中文摘要: |
| 摘要 目的：分析急性髓系白血病（AML）患者血小板输注疗效不佳及短期死亡的危险因素。方法：将2019年4月至2021年1月期间南部战区总医院收治的97例AML患者作为研究对象，在常规化疗的基础上，所有患者均进行血小板输注治疗。将血小板输注24 h后血小板计数增加指数<4.5视为输注疗效不佳，反之则为输注疗效良好。随访1年，根据短期预后的不同将患者分为死亡组和生存组。采用单因素和多因素Logistic分析AML患者血小板输注疗效不佳及短期死亡的危险因素。结果：97例AML患者中，疗效良好的患者65例，疗效不佳的患者32例，根据血液输注疗效将患者分为疗效不佳组（n=32）和疗效良好组（n=65）。随访结束时，97例AML患者中，有21例患者病死，病死率为21.65%。将病死的患者纳为死亡组（n=21），存活的患者纳为生存组（n=76）。AML患者血小板输注疗效不佳与白细胞计数（WBC）、输注次数、出血量、脾脏大小、感染发热、血小板种类有关（P<0.05），而与性别、年龄、血型、疾病类型、降钙素原（PCT）、血红蛋白（Hb）、乙肝表面抗原无关（P>0.05）。AML患者血小板输注疗效不佳的多因素Logistic分析结果表明：WBC＞50×109/L、输注次数≥7次、出血量≥400 mL、脾大、感染发热、血小板种类为冰冻是AML患者血小板输注疗效不佳的危险因素（P<0.05）。AML患者短期死亡与弥散性血管内凝血、感染发热、血小板抗体、应用烷化剂化疗药物、脾脏大小有关（P<0.05），AML患者短期死亡的多因素Logistic分析结果表明：血小板抗体阳性、感染发热、脾大、弥散性血管内凝血是AML患者短期死亡的危险因素（P<0.05）。结论：AML患者血小板输注疗效不佳受到WBC、输注次数、出血量、脾脏大小、感染发热、血小板种类等因素的影响。此外，感染发热、弥散性血管内凝血、血小板抗体、脾脏大小等是AML患者血小板输注后短期预后的影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the risk factors of poor efficacy of platelet transfusion and short-term death in patients with acute myeloid leukemia (AML). Methods: 97 patients with AML who were admitted to the Southern Theater General Hospital from April 2019 to January 2021 were selected as subjects. On the basis of conventional chemotherapy, all patients received platelet infusion therapy. Platelet count increase index less than 4.5 at 24 h after platelet infusion, it is considered that the transfusion effect was poor, otherwise, it is considered that the transfusion effect was good. The patients were followed up for 1 year, and they were divided into death group and survival group according to short-term prognosis. Univariate and multivariate Logistic analyses were used to analyze the risk factors of poor platelet infusion and short-term death in patients with AML. Results: Among 97 patients with AML, 65 patients had good efficacy, 32 patients had poor efficacy. According to the efficacy of blood transfusion, the patients were divided into poor efficacy group (n=32) and good efficacy group (n=65). At the end of follow-up, among 97 patients with AML, 21 patients died, with a fatality rate of 21.65%. The dead patients were included in the death group (n=21), and the surviving patients were included in the survival group (n=76). The poor efficacy of platelet transfusion in patients with AML was related to white blood cell count (WBC), transfusion times, bleeding volume, spleen size, infection and fever, and platelet types (P<0.05). The multivariate Logistic analysis of the poor efficacy of platelet transfusion in patients with AML showed that WBC＞50×109/L, transfusion times≥7 times, bleeding volume≥400 mL, splenomegaly, infection and fever, and platelet types with frozen were risk factors for poor efficacy of platelet transfusion in patients with AML(P<0.05). The short-term death of patients with AML was related to infection and fever, disseminated intravascular coagulation, use of alkylating agents and chemotherapy drugs, platelet antibody, and spleen size (P<0.05), but not to gender, age, body mass index, diabetes, hypertension, hyperlipidemia, smoking history, and drinking history(P>0.05). The multivariate Logistic analysis of short-term death in patients with AML showed that infection and fever, disseminated intravascular coagulation, positive platelet antibody and splenomegaly were the risk factors of short-term death in patients with AML(P<0.05). Conclusion: The poor efficacy of platelet transfusion in patients with AML is affected by factors such as WBC, infusion number, bleeding volume, spleen size, infection and fever, and platelet type. In addition, infection and fever, disseminated intravascular coagulation, platelet antibodies, and spleen size are factors affecting the short-term prognosis of patients with AML after platelet infusion. |
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