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目的探讨儿童急性白血病(AL)在院死亡原因及相关因素。方法回顾性分析广州市儿童医院1999年1月-2007年3月收治的42例AL患儿死亡病例资料。男19例,女23例;年龄4个月～12岁5个月。42例中急性淋巴细胞性白血病(ALL)21例,急性髓细胞性白血病(AML)18例,未分型3例。结果12例患儿未经治疗早期死亡者10例,分别死于疾病浸润和颅内及肺出血。接受化疗的30例中早期死于出血者4例,中后期多死于骨髓抑制并发的感染,其中败血症14例,真菌感染3例,病毒感染1例,不明病原4例。23例化疗后完全缓解者中,复发16例(70%),累计28例次,50%发生在初治1a内。治疗相关死亡27例,占治疗总数的90%,主要死因为感染,其次为出血。细菌居感染病原之首。初诊时出血及高白细胞血症是白血病早期死亡的2大危险因素。结论应重视并纠正儿童AL治疗早期出血倾向,尤其是急性早幼粒细胞白血病。积极防治诱导化疗中感染并发症,降低化疗相关病死率。
Objective To investigate the causes and related factors of childhood acute leukemia (AL) death at hospital. Methods A retrospective analysis of Guangzhou Children’s Hospital in January 1999 -2007 in March admitted 42 cases of children with AL data. 19 males and 23 females; aged 4 months to 12 years and 5 months. Among the 42 cases, 21 were acute lymphoblastic leukemia (ALL), 18 were acute myeloid leukemia (AML) and 3 were untreated. Results Twelve cases of early death in untreated patients died of disease infiltration and intracranial and pulmonary hemorrhage respectively. Among the 30 patients who received chemotherapy, 4 died of hemorrhage in the early stage and the other died of myelosuppression in the middle and late stages. Among them, 14 were sepsis, 3 were fungal infections, 1 was viral infection and 4 was unknown. In 23 cases of complete remission after chemotherapy, 16 cases (70%) relapsed, a total of 28 cases, 50% occurred in the initial treatment 1a. Treatment-related deaths in 27 cases, accounting for 90% of the total number of treatment, the main cause of death is infection, followed by bleeding. Infectious bacteria first in the pathogen. Bleeding and hypervolemia at first diagnosis are two major risk factors for early death of leukemia. Conclusions Children with AL should pay attention to and correct the early bleeding tendency, especially acute promyelocytic leukemia. Active prevention and treatment of chemotherapy in the infection complications, reduce chemotherapy-related mortality.