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目的 探讨急性白血病 (AL)患者颅内出血 (ICH)相关因素 ,以便采取相应的预防措施 ,降低其病死率。方法 回顾分析我院血液科 1989年 12月至 2 0 0 2年 8月发生ICH的AL患者 16 1例 (ICH组 )的临床和实验室资料 ,并随机抽取同期住院的无ICH的AL患者 16 9例为对照组 (非ICH组 )。结果 ICH最多见于慢性粒细胞性白血病(CML)急变期患者 (13.89% ) ,其次为急性单核细胞性白血病 (M5) (9.79% )和急性早幼粒细胞白血病 (M3 ) (9.17% )患者 ,急性髓细胞性白血病比急性淋巴细胞白血病容易发生ICH。ICH与血小板减少、低血红蛋白水平、疾病病程、合并感染和高白细胞计数等密切相关 ;头颈部出血往往是ICH的先兆。ICH的Logistic回归结果表明 ,ICH的几率随着白细胞 (WBC)的增高而上升 ,随血小板 (Plt)的上升而下降。WBC每增加 1个单位 ,ICH的几率就增加大约 0 .6 % ;Plt每增加 1个单位 ,颅内出血的几率就减少大约 0 .8%。结论 ICH与严重的血小板减少、高白细胞计数密切相关 ,如这些患者出现头颈部出血预示ICH即将发生 ,应及时采取相应干预措施预防ICH。
Objective To investigate the related factors of intracranial hemorrhage (ICH) in patients with acute leukemia (AL) so as to take corresponding preventive measures and reduce their mortality. Methods The clinical and laboratory data of 161 patients with ICH in ICH who underwent hematology in our hospital from December 1989 to August 2002 were retrospectively analyzed. A total of 16 patients with AL without ICH Nine cases were control group (non-ICH group). Results ICH was found most frequently in patients with chronic myeloid leukemia (CML) in the blastic phase (13.89%), followed by acute monocytic leukemia (M5) (9.79%) and acute promyelocytic leukemia (M3) , Acute myeloid leukemia than acute lymphoblastic leukemia prone ICH. ICH and thrombocytopenia, low hemoglobin levels, disease duration, co-infection and high white blood cell count is closely related; head and neck hemorrhage is often a precursor to ICH. Logistic regression analysis of ICH showed that the probability of ICH increased with the increase of white blood cell (WBC) and decreased with the increase of platelet (Plt). The probability of ICH increased by about 0.6% for each additional unit of WBC; for each additional unit of Plt, the chance of intracranial hemorrhage decreased by about 0.8%. Conclusions ICH is closely related to severe thrombocytopenia and high white blood cell count. For example, head-and-neck hemorrhage in these patients indicates that ICH is imminent. Corresponding intervention measures should be taken to prevent ICH.