Zhang Qiaolei, Li Xueying, Wei Zhangyue, Ye Xiujin, Zhu Lixia, Xie Mixue, Xie Wanzhuo, Zhu Jingjing, Li Li, Zhou De, Zheng Yanlong, Yang Xiudi, Zhu Mingyu, Sun Jianai
Department of Hematology, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China; Department of Hematology, Lishui People's Hospital, Lishui, Zhejiang Province, China.
Department of Hematology, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China.
J Clin Neurosci. 2017 Oct;44:203-206. doi: 10.1016/j.jocn.2017.06.058. Epub 2017 Jul 8.
Although high mortality in patients with acute leukemia (AL) is associated with intracranial hemorrhage (ICH), the clinical features and pathogenesis of AL patients with cerebral hemorrhage are not well known.
We diagnosed 90 patients with ICH from a total of 1467 patients with non-promyelocytic AL who had been hospitalized in the First Affiliated Hospital of Medical School of Zhejiang University from January 2010 to October 2015. Moreover, the risk factors of ICH death were evaluated.
Median age at ICH was 51years old, in which men accounted for 52.2%. They also accounted for 85.6% of acute myeloid leukemia. The relative incidence of ICH was the highest in M2 and M5 (60.1%). ICH presented with higher peripheral blood white blood cell count (WBC) (P<0.001), lower peripheral platelet counts (P<0.001), lower albumin (P<0.001), lower fibrous protein (P<0.001) and prolongation of prothrombin time (P<0.001) compared to those observed in the patients of NICH group; multivariate analysis, independent risk factors for death in patients with ICH include: WBC≥30.00×109/l and prothrombin time≥12.91 s.
Leukocytosis and coagulation dysfunctions might be the main pathogenesis of acute leukemia complicated with cerebral hemorrhage.
虽然急性白血病(AL)患者的高死亡率与颅内出血(ICH)相关,但脑出血的AL患者的临床特征和发病机制尚不清楚。
我们从2010年1月至2015年10月在浙江大学医学院附属第一医院住院的1467例非早幼粒细胞性AL患者中诊断出90例ICH患者。此外,评估了ICH死亡的危险因素。
ICH患者的中位年龄为51岁,其中男性占52.2%。他们也占急性髓细胞白血病的85.6%。ICH的相对发病率在M2和M5中最高(60.1%)。与非ICH组患者相比,ICH患者外周血白细胞计数(WBC)更高(P<0.001)、外周血小板计数更低(P<0.001)、白蛋白更低(P<0.001)、纤维蛋白更低(P<0.001)以及凝血酶原时间延长(P<0.001);多因素分析显示,ICH患者死亡的独立危险因素包括:WBC≥30.00×10⁹/L和凝血酶原时间≥12.91秒。
白细胞增多和凝血功能障碍可能是急性白血病并发脑出血的主要发病机制。