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目的 探讨亚砷酸对急性旱幼粒细胞白血病 (APL)合并DIC的治疗和恢复有何影响及其临床特征和高危因素。方法 收集我院近 4年 1 6 8例应用亚砷酸治疗的APL患者 ,其中合并DIC的 1 2 0例 ,分初治组和复发组。高白期加羟基脲或暂停亚砷酸以治疗DIC为主。应用SAS软件分析APL合并DIC的高危因素并归纳出DIC的类型。结果 临床表现以皮肤黏膜出血为著。DIC发生率初治组与复发组分别为 72 .2 2 %和 6 9.0 5 % ;DIC治愈率分别为89.91 %与 75 .86 % ;死亡率分别为 1 2 .0 8%和 2 4 .1 4 %。高危因素与WBC、PLT、LDH值 ,脏器出血及栓塞有关。结论 亚砷酸治疗APL无直接诱发DIC的作用 ,未发现其促纤溶作用。DIC治疗以输注血小板、纤维蛋白原、血浆等加肝素为主 ,早期高白 ,血小板≤ 1 0× 1 0 9 L ,尤其是LDH增高预示高危 ,死亡率极高。
Objective To investigate the effect of arsenious acid on the treatment and recovery of acute promyelocytic leukemia (APL) combined with DIC and its clinical characteristics and risk factors. Methods A total of 186 APL patients treated with arsenite were collected in our hospital in the past 4 years, including 120 cases with DIC combined with primary treatment and relapse. High white plus hydroxyurea or suspended arsenic to treat DIC-based. SAS software was used to analyze the risk factors of APL combined DIC and to conclude the type of DIC. Results The clinical manifestations of mucocutaneous bleeding. The incidence of DIC was 72.22% and 6.95% respectively in the initial group and the recurrence group; the cure rates of DIC were 89.91% and 75.86% respectively; the mortality rates were 12.08% and 24.1 4%. Risk factors and WBC, PLT, LDH values, organ bleeding and embolism. Conclusion Arsenite treatment of APL did not directly induce the role of DIC, did not find its role in promoting fibrinolysis. DIC treatment of platelets, fibrinogen, plasma plus heparin-based, early high white, platelet ≤ 1 0 × 109L, especially increased LDH predicts high risk, high mortality.