Su M H, Yan Z S, Li Q L, Zhang J Y, Yin Y K, Hu B, Liu Y Z, Li D P, Mi Y C
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 Tianjin Institutes of Health Science, Tianjin 301600, China.
Zhonghua Xue Ye Xue Za Zhi. 2025 Jan 14;46(1):53-57. doi: 10.3760/cma.j.cn121090-20240917-00351.
This study analyzed the clinical characteristics and early mortality risk factors in patients with hyperleukocytic acute leukemia (HAL) to provide a basis for predicting early prognosis. Data were retrospectively collected from 211 patients with primary HAL who visited the Emergency Center of the Hematology Hospital, Chinese Academy of Medical Sciences, between July 1, 2019 and November 30, 2021. The value of each indicator in early risk stratification and prognosis was analyzed. The early-death group exhibited higher WBC, peripheral blood immature cell proportions, prothrombin times (PT), fibrinogen degradation products (FDP), and D-dimer levels than the non-early death group (<0.05). Mortality in hyperleukocytic AML (20.5% ) was significantly higher than that in hyperleukocytic ALL (9.3% ) (<0.05). There were significant differences in age, creatinine, PT, fibrinogen (FIB) levels, WBC, lactic dehydrogenase (LDH), uric acid, blood potassium, blood calcium, and blood phosphorus levels between the two groups of patients (<0.05). A WBC threshold of 255.96×10⁹/L predicted early mortality with 65.6% sensitivity and 69.0% specificity, with higher WBC levels associated with a 5.164-fold increased mortality risk (<0.05). The age, WBC, LDH, urea, PT, FDP and D-dimer of patients at the time of consultation are risk factors affecting the survival of HAL (<0.05) . HAL is a life-threatening condition with a high early mortality. Age, WBC, LDH, urea, PT, FDP and D-dimer are risk factors for early death in HAL.
本研究分析了高白细胞急性白血病（HAL）患者的临床特征及早期死亡风险因素，为预测早期预后提供依据。回顾性收集了2019年7月1日至2021年11月30日期间就诊于中国医学科学院血液病医院急诊科的211例原发性HAL患者的数据。分析了各指标在早期风险分层及预后中的价值。早期死亡组的白细胞、外周血未成熟细胞比例、凝血酶原时间（PT）、纤维蛋白原降解产物（FDP）及D-二聚体水平均高于非早期死亡组（<0.05）。高白细胞急性髓系白血病的死亡率（20.5%）显著高于高白细胞急性淋巴细胞白血病（9.3%）（<0.05）。两组患者在年龄、肌酐、PT、纤维蛋白原（FIB）水平、白细胞、乳酸脱氢酶（LDH）、尿酸、血钾、血钙及血磷水平方面存在显著差异（<0.05）。白细胞阈值为255.96×10⁹/L时预测早期死亡的敏感度为65.6%，特异度为69.0%，白细胞水平越高，死亡风险增加5.164倍（<0.05）。患者就诊时的年龄、白细胞、LDH、尿素、PT、FDP及D-二聚体是影响HAL生存的风险因素（<0.05）。HAL是一种危及生命的疾病，早期死亡率高。年龄、白细胞、LDH、尿素、PT、FDP及D-二聚体是HAL早期死亡的风险因素。
