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目的分析急性早幼粒细胞白血病(APL)患者临床特点,探讨分层治疗方案选择。方法选取初诊APL患者43例,分为中低危组和高危组,中低危组采用全反式维甲酸(ATRA)联合化疗(72 h后)实施诱导缓解,高危组采用ATRA联合亚砷酸(As2O3)及化疗(24小时内)实施诱导缓解,对比分析两组临床特点及疗效。结果 43例初诊APL患者,中低危组29例,高危组14例。高危组APL患者中,早期死亡3/14例(21.4%)高于中低危组3/29例(10.3%),但两组比较无显著性差异(p>0.05);弥散性血管内凝血(DIC)发生率6/14例(42.9%)高于中低危组4/29例(13.8%),维早酸综合征(4/14例,28.6%)高于中低危组0/29例,毛细血管渗漏综合征5/14例(45.5%)高于中低危组0/29例,且均有显著性差异(P<0.05)。结论 1高危组APL患者治疗中应警惕DIC、维早酸综合征、毛细血管渗漏综合征等。2APL患者应分层治疗,针对高危患者可考虑ATRA联合As2O3及化疗(24 h内)方案治疗。
Objective To analyze the clinical characteristics of patients with acute promyelocytic leukemia (APL) and discuss the choice of stratification treatment. Methods Forty-three patients with newly diagnosed APL were divided into moderate and low risk group and high risk group. ATRA combined with chemotherapy (after 72 h) was used to induce remission in middle and low risk group. ATRA combined with arsenious acid (As2O3) and chemotherapy (24 hours) to induce remission, comparative analysis of two groups of clinical features and efficacy. Results 43 cases of newly diagnosed APL patients, 29 cases of low-risk group, 14 cases of high-risk group. Among the high-risk APL patients, 3/14 cases (21.4%) of early death were higher than 3/29 cases (10.3%) of middle-low risk group, but there was no significant difference between the two groups (p> 0.05); diffuse intravascular coagulation The incidence of DIC was higher in 6/14 cases (42.9%) than in middle and low risk groups (4/29 cases, 13.8%), and in 4/14 cases (28.6% 29 cases, 5/14 cases (45.5%) of capillary leak syndrome were higher than 0/29 cases of middle and low risk group, and there was significant difference (P <0.05). Conclusions 1 High-risk APL patients should be vigilant in the treatment of DIC, vitamin A acid syndrome, capillary leak syndrome. 2APL patients should be stratified treatment, high-risk patients may consider ATRA combined with As2O3 and chemotherapy (within 24 h) program.