CAJ | 학술논문

目的：分析急性早幼粒细胞白血病(APL)患者临床特点，探讨分层治疗方案选择。方法选取初诊APL患者43例，分为中低危组和高危组，中低危组采用全反式维甲酸(ATRA)联合化疗（72 h后）实施诱导缓解，高危组采用ATRA联合亚砷酸（As2O3）及化疗（24小时内）实施诱导缓解，对比分析两组临床特点及疗效。结果43例初诊APL患者,中低危组29例，高危组14例。高危组APL患者中,早期死亡3/14例(21.4%)高于中低危组3/29例(10.3%)，但两组比较无显著性差异(p>0.05)；弥散性血管内凝血（DIC）发生率6/14例(42.9%)高于中低危组4/29例(13.8%)，维早酸综合征(4/14例,28.6%)高于中低危组0/29例，毛细血管渗漏综合征5/14例(45.5%)高于中低危组0/29例，且均有显著性差异(P<0.05)。结论①高危组APL患者治疗中应警惕DIC、维早酸综合征、毛细血管渗漏综合征等。②APL患者应分层治疗，针对高危患者可考虑ATRA 联合As2O3及化疗（24 h内）方案治疗。
목적：분석급성조유립세포백혈병(APL)환자림상특점，탐토분층치료방안선택。방법선취초진APL환자43례，분위중저위조화고위조，중저위조채용전반식유갑산(ATRA)연합화료（72 h후）실시유도완해，고위조채용ATRA연합아신산（As2O3）급화료（24소시내）실시유도완해，대비분석량조림상특점급료효。결과43례초진APL환자,중저위조29례，고위조14례。고위조APL환자중,조기사망3/14례(21.4%)고우중저위조3/29례(10.3%)，단량조비교무현저성차이(p>0.05)；미산성혈관내응혈（DIC）발생솔6/14례(42.9%)고우중저위조4/29례(13.8%)，유조산종합정(4/14례,28.6%)고우중저위조0/29례，모세혈관삼루종합정5/14례(45.5%)고우중저위조0/29례，차균유현저성차이(P<0.05)。결론①고위조APL환자치료중응경척DIC、유조산종합정、모세혈관삼루종합정등。②APL환자응분층치료，침대고위환자가고필ATRA 연합As2O3급화료（24 h내）방안치료。
Objective To analysis the clinical characteristics of acute promyelocytic leukemia (APL) between the medium low, and high risk group, and to explore the stratified treatment choice. Methods 43 cases who were newly diagnosed to acute promyelocytic leukemia were divided into, medium low and high risk group. The medium low risk group was treated with all trans retinoic acid (ATRA) combined with chemotherapy (after 72 hours), while the high risk group was treated by ATRA, arsenic trioxide (As2O3) and chemotherapy (within 24 hours). Clinical features and effects between two groups were compared. Results There are 29 cases who belonged to medium low risk group, 14 cases belonging to high risk group. There were 3 cases appeared early death in high-risk group (21.4%) ,which was higher than that in medium low risk group (10.3%), but the difference was no significant (P>0.05);Incidence of DIC was 42.9%in high rish group, which was higher than that in medium low risk group (13.8%). RAS syndrome rate in high rish group was 28.6%(4/14), which was higher than that in medium low risk group .Capillary leak syndrome rate (5/14 cases, (45.5%) was significantly higher than that in medium low risk group (P<0.05). Conclusion 1. APL in the high risk group should be alert for the DIC, RAS and capillary leakage syndrome. 2. The stratified treatment should be explored in APL patients. High-risk patients could be considered ATRA combined with As2O3 and chemotherapy (within 24 hours) regimen.