Abu el-Asrar A M, al-Momen A K, Kangave D, Harakati M S
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Doc Ophthalmol. 1995;91(3):273-81. doi: 10.1007/BF01204178.
This prospective study evaluates the relationship, between the fundus findings in leukemic retinopathy and the survival in patients with newly diagnosed acute leukemia. Fifty-four newly diagnosed consecutive patients with acute leukemia were included in this study. The patients were examined within few days of initial admission and diagnosis. Leukemic retinopathy was detected in 19 (35%) patients. The observation period ranged from 434 days to 1220 days (mean +/- SD 880 +/- 225) for those patients who survived. Despite similar chemotherapy compared to those without retinopathy (332.4 +/- 99.6 and 76 vs. 640.7 +/- 106 and 192 days respectively) although survival did not differ significantly (p = 0.073). Patients with cotton-wool spots had lower mean and median survival times than did those without such lesions (168.8 +/- 70.9 and 27 vs. 609.4 +/- 91.4 and 289 days respectively) and survival differed significantly (p = 0.04). The presence of cotton-wool spots and age > or = 40 years were the major adverse prognostic factors for survival in multivariate analysis. Cotton-wool spots had a more significant adverse prognostic effect than age > or = 40 years (hazard function coefficients: 1.0708 for cotton-wool spots vs 0.0355 for age > or = 40 years). The relative odds of dying among patients with cotton-wool spots were about 8 times higher than that for those without this feature, and about 7 times higher in patients aged > or = 40 years than that for patients aged < 20 years. Our findings suggest that the presence of leukemic retinopathy in general, and cotton-wool spots, in particular is a poor prognostic sign for survival in acute leukemia.
这项前瞻性研究评估了白血病视网膜病变的眼底表现与新诊断急性白血病患者生存率之间的关系。本研究纳入了54例连续新诊断的急性白血病患者。患者在初次入院和诊断后的几天内接受检查。19例（35%）患者检测出白血病视网膜病变。存活患者的观察期为434天至1220天（平均±标准差880±225天）。尽管与无视网膜病变的患者接受了相似的化疗（分别为332.4±99.6天和76例与640.7±106天和192例），但生存率差异无统计学意义（p = 0.073）。有棉絮斑的患者的平均和中位生存时间低于无此类病变的患者（分别为168.8±70.9天和27例与609.4±91.4天和289例），且生存率差异有统计学意义（p = 0.04）。在多因素分析中，棉絮斑的存在和年龄≥40岁是生存的主要不良预后因素。棉絮斑的不良预后作用比年龄≥40岁更显著（风险函数系数：棉絮斑为1.0708，年龄≥40岁为0.0355）。有棉絮斑的患者死亡的相对几率比无此特征的患者高约8倍，年龄≥40岁的患者比年龄<20岁的患者高约7倍。我们的研究结果表明，一般来说白血病视网膜病变的存在，特别是棉絮斑的存在是急性白血病生存的不良预后标志。
