血液病颅内出血患者的临床特征和预后因素。
Clinical characteristics and prognostic factors in intracranial hemorrhage patients with hematological diseases.
机构信息
Department of Emergency, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China.
Department of Radiology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China.
出版信息
Ann Hematol. 2022 Dec;101(12):2617-2625. doi: 10.1007/s00277-022-04982-w. Epub 2022 Sep 30.
The clinical characteristics and prognosis of intracranial hemorrhage (ICH) in patients with hematological diseases remain controversial. This study aimed to describe the clinical characteristics and explore the prognostic factors in such patients. A total of 238 ICH patients with a hematological disease were recruited from the Institute of Hematology and Blood Diseases Hospital, China, from January 2015 to April 2020. The Cox proportional hazards model was used to identify the prognostic factors for 30-day mortality in ICH patients with a hematological disease. There were 123 cases of acute leukemia (AL), 20 of myelodysplasia/myeloproliferative neoplasm, 35 of aplastic anemia (AA), 29 of immune thrombocytopenia (ITP), 19 of congenital/acquired coagulation factor deficiency, and 12 of other hematological diseases. Furthermore, 121 patients presented with a multi-site hemorrhage (MSH), 58 with a single-site hemorrhage in the brain parenchyma (PCH), 23 with a subarachnoid hemorrhage, 33 with a subdural hemorrhage (SH), and three with an epidural hemorrhage. The Cox proportional hazards model indicated association of SH (vs PCH, hazard ratio [HR]: 0.230; 95% confidence interval [CI]: 0.053-0.996; P = 0.049), low white blood cells (≤ 100 × 10/L vs > 100 × 10/L, HR: 0.56; 95% CI: 0.348-0.910; P = 0.019), AA (vs AL, HR: 0.408; 95% CI: 0.203-0.821; P = 0.012), and ITP (vs AL, HR: 0.197; 95% CI: 0.061-0.640; P = 0.007) with improved 30-day mortality. However, increased age (HR: 1.012; 95% CI: 1.001-1.022; P = 0.034), MSH (vs PCH, HR: 1.891; 95% CI: 1.147-3.117; P = 0.012), and a disturbance of consciousness (HR: 1.989; 95% CI: 1.269-3.117; P = 0.003) were associated with increased risk of 30-day mortality. In conclusion, in this study, we revealed the clinical characteristics of Chinese ICH patients with a hematological disease. Moreover, we identified risk factors (age, white blood cells, AA, ITP, SH, MSH, and a disturbance of consciousness) that may influence 30-day mortality.
血液病患者颅内出血（ICH）的临床特征和预后仍存在争议。本研究旨在描述此类患者的临床特征，并探讨其预后因素。我们共纳入了 2015 年 1 月至 2020 年 4 月期间中国血液病研究所血液病合并 ICH 的 238 例患者。采用 Cox 比例风险模型确定血液病合并 ICH 患者 30 天死亡率的预后因素。其中急性白血病（AL）123 例、骨髓增生异常/骨髓增殖性肿瘤 20 例、再生障碍性贫血（AA）35 例、免疫性血小板减少症（ITP）29 例、先天性/获得性凝血因子缺乏症 19 例、其他血液病 12 例。此外，121 例患者表现为多部位出血（MSH），58 例为脑实质（PCH）单部位出血，23 例为蛛网膜下腔出血，33 例为硬膜下出血（SH），3 例为硬膜外出血。Cox 比例风险模型显示 SH（与 PCH 相比，风险比 [HR]：0.230；95%置信区间 [CI]：0.053-0.996；P=0.049）、低白细胞计数（≤100×10/L 与>100×10/L 相比，HR：0.56；95%CI：0.348-0.910；P=0.019）、AA（与 AL 相比，HR：0.408；95%CI：0.203-0.821；P=0.012）和 ITP（与 AL 相比，HR：0.197；95%CI：0.061-0.640；P=0.007）与改善的 30 天死亡率相关。然而，年龄增加（HR：1.012；95%CI：1.001-1.022；P=0.034）、MSH（与 PCH 相比，HR：1.891；95%CI：1.147-3.117；P=0.012）和意识障碍（HR：1.989；95%CI：1.269-3.117；P=0.003）与 30 天死亡率的增加相关。总之，在这项研究中，我们揭示了中国血液病合并 ICH 患者的临床特征。此外，我们确定了可能影响 30 天死亡率的危险因素（年龄、白细胞计数、AA、ITP、SH、MSH 和意识障碍）。
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