【作者】 刘丽；

【导师】 吴广胜；

【作者基本信息】 石河子大学 ， 内科学（专业学位）， 2018， 硕士

【摘要】 目的:分析急性髓系白血病患者诱导化疗后血小板计数变化情况,评估其与骨髓缓解的相关性,探索预测AML疗效简单易行的早期指标。方法:收集2010年1月--2016年12月石河子大学第一附属医院血液科明确诊断为AML且接受标准DA化疗方案的152例患者临床资料,排除姑息性治疗、未接受标准化疗、急性早幼粒细胞白血病(APL)、骨髓增生异常综合症(MDS)、骨髓增值性肿瘤(MPN)等疾病转化为AML及治疗相关性白血病。根据化疗结束后第14天骨髓缓解情况分为完全缓解组(CR)92例与未完全缓解组(PR+NR)60例,分别收集两组患者的性别、年龄、初诊时外周血白细胞计数(WBC)、血红蛋白浓度(HB)、血小板计数(PLT)及化疗结束后骨髓恢复早期(第10天)、完全恢复期(第14天)PLT计数资料,采用SPSS19.0统计软件进行数据处理,计量资料不符合正态分布以M(P25;P75)表示,比较采用秩和检验;计数资料采用频数、百分比表示,比较采用X~2检验。结果:AML患者诱导化疗后不同骨髓缓解组患者的性别、初诊时血红蛋白浓度、血小板计数与患者CR率比较差异无统计学意义(P>0.05);诱导化疗后骨髓未完全缓解组患者年龄≥60岁、初诊时白细胞计数≥30×10~9/L及首次诱导未达CR的患者总CR率明显低于无上述因素者(P<0.05);通过动态观察化疗结束后第10天、14天血小板计数变化情况,92例骨髓完全缓解组患者PLT计数均高于60例未完全缓解组患者(P<0.05);化疗结束后第10天,92例完全缓解组患者中76例PLT≥20×10~9/L,其中42例>50×10~9/L;60例未完全缓解组患者中32例≥20×10~9/L,仅10例>50×10~9/L(P<0.05);化疗结束后第14天骨髓完全缓解组患者PLT≥100×10~9/L所占比例明显高于未完全缓解组(P<0.01)。结论:1.AML患者的性别、初诊时血红蛋白浓度、血小板计数与其骨髓缓解率无关;2.年龄≥60岁、初诊时白细胞计数≥30×10~9/L及首次诱导未达CR的AML患者总CR率明显低于无上述因素者;3.AML患者诱导化疗后血小板计数的动态变化与骨髓造血功能的恢复有一定的相关性,化疗后血小板计数增多者疗效相对较好,可作为临床上预测AML疗效简单易行的早期监测指标之一。更多还原

【Abstract】 Objective:To analyze the change of platelet count after induction of chemotherapy in patients with diagnosed acute myeloid leukemia,evaluate its correlation with bone marrow remission,and explore early indicators that predict the efficacy of AML.Methods:Collection of clinical data of 152 patients diagnosed as AML and undergoing standard DA chemotherapy from Department of Hematology,First Affiliated Hospital,Shihezi University from January 2010 to December 2016,excluding palliative care,non-standard chemotherapy,and Acute Promyelocytic Leukemia(APL),diseases such as myelodysplastic syndrome(MDS)and bone marrow-derived(MPN)tumors are converted to AML and treatment-related leukemia.According to the bone marrow remission at the 14th day after the end of chemotherapy,there were 92 cases of complete remission(CR)and 60 cases of incomplete remission(PR+NR).The gender,age,white blood cell count(WBC),hemoglobin concentration(HB),platelet count(PLT)at the first visit,and PLT count data at the early bone marrow recovery(10th)and the fully convalescent(14th)days after the end of chemotherapy were collected.SPSS 19.0 statistics software were used for data processing,the measurement data does not conform to the normal distribution to M(p25,p75),compared to the use of rank and test,counting data are expressed in terms of frequency and percentage,and compared with X~2 test.Results:There was no significant difference in the gender,the hemoglobin concentration,the platelet count and the CR rate of the patients with different bone marrow relieving group after the induction chemotherapy in the diagnosed AML patients(P>0.05);The total CR rate in patients with incomplete bone marrow remission after induction chemotherapy was≥60 years old,the white blood cell count at the initial visit was≥30×10~9/L,and the total CR rate was significantly lower than those without the first induction(P<0.05);By dynamically observing the changes of platelet counts on the 10th and 14th days after the end of chemotherapy,the PLT co unts in 92 patients with bone marrow complete remission were higher than those in 60 patients with incomplete remission(P<0.05);On the 10th day after chemotherapy,92 patients with complete remission group(76cases)were PLT≥20×10~9/L,of which 42>50×10~9/L;60 cases were not completely relieved in 32 cases≥20×10~9/L,only 10 cases>50×10~9/L(P<0.05);At the 14th dayafter chemotherapy,the proportion of PLT≥100×10~9/L was significantly higher in the bone marrow complete remission group than in the incomplete remission group(P<0.01).Conclusion:1.Gender,initial hemoglobin concentration,and platelet count of diagnosed AML patients were not related to bone marrow remission rate;2.AML patients aged≥60 years,white blood cell count at the time of first visit≥30×10~9/L,and first induction of non-CR-The total CR rate was significantly lower than those without the above factors;3.The dynamic change of plateletc ount after induction of chemotherapy in diagnosed AML patients has a certain correlation with the recovery of bone marrow hematopoietic function.The increase of platelet count after chemotherapy is relatively effective,and can be used as a simple clinical assessment of the efficacy of AML One of the monitoring indicators.更多还原