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目的分析研究急性早幼粒细胞性白血病患者的临床特点和预后情况。方法回顾性分析73例急性早幼粒细胞性白血病患者的临床特点和预后情况。结果 73例患者常见的临床症状有:发热69例,贫血43例,淋巴结肿大39例,肝肿大39例,脾肿大30例,骨关节疼痛8例。56例(77%)患者出现皮肤瘀斑,69例(95%)患者出现各部位出血情况,其中尤其以皮肤黏膜出血最为常见,发生率为86%(63/73),51例(70%)患者出现了弥散性血管内凝血。73例患者中,低危患者10例,中危患者40例,高危患者23例。73例患者中16例死亡,57例完全缓解,其中复发12例,持续性完全缓解45例。低、中危患者的完全缓解率为82%(41/50),高于高危患者的70%(16/23),但差异并无统计学意义(P>0.05)。73例患者接受治疗后1年无事件生存率为70%(51/73),3年无事件生存率为63%(46/73),5年无事件生存率为52%(38/73)。高危患者5年无事件生存率为39%(9/23),中危患者5年无事件生存率为58%(23/40),低危患者5年无事件生存率为60%(6/10)。结论出血是急性早幼粒细胞性白血病患者最常见也是最显著的临床症状,临床上运用全反式维甲酸联合其他药物治疗急性早幼粒细胞性白血病效果显著,可以降低早期病死率。可根据患者外周血幼稚细胞比例等临床预后因素,制定个性化治疗方案,对于提高患者存活率具有重大指导意义,值得在临床上推广使用。
Objective To analyze the clinical features and prognosis of patients with acute promyelocytic leukemia. Methods The clinical features and prognosis of 73 patients with acute promyelocytic leukemia were retrospectively analyzed. Results The clinical symptoms of the 73 patients were as follows: fever in 69 cases, anemia in 43 cases, lymph node enlargement in 39 cases, hepatomegaly in 39 cases, splenomegaly in 30 cases and bone and joint pain in 8 cases. In 56 patients (77%), skin ecchymosis was observed in 69 cases (95%). Bleeding in various parts of the skin was the most common, with the incidence of 86% (63/73), 51 cases (70% ) Patients had disseminated intravascular coagulation. Of the 73 patients, 10 were in low-risk patients, 40 in moderate-risk patients, and 23 in high-risk patients. Of the 73 patients, 16 were dead and 57 were completely relieved, with 12 recurrent and 45 persistent complete remission. The complete remission rate was 82% (41/50) in low and intermediate risk patients, which was higher than that in high risk patients (70%, 16/23), but the difference was not statistically significant (P> 0.05). One year after treatment, 73 patients had an event-free survival rate of 70% (51/73), a 3-year event-free survival rate was 63% (46/73) and a 5-year event-free survival rate was 52% (38/73) . The 5-year event-free survival rate was 39% (9/23) in high-risk patients, 5-year event-free survival rates were 58% (23/40) in moderate-risk patients, and 5-year event-free survival rates were 60% 10). Conclusion Hemorrhage is the most common and most prominent clinical symptom in patients with acute promyelocytic leukemia. The clinical application of all-trans retinoic acid combined with other drugs in the treatment of acute promyelocytic leukemia is significant and can reduce the early mortality. According to the proportion of patients with peripheral blood naive cells and other clinical prognostic factors to develop personalized treatment programs for the survival rate of patients with great guiding significance, it is worth promoting in clinical use.