Analysis Of Factors Affecting The Initial Treatment Of Acute Promyelocytic Leukemia With Disseminated Intravascular Coagulation

PurposeIn this study,we used retrospective study to evaluate whether there was DIC in the newly diagnosed APL patients who were admitted to the Hematology Department of Chinese People’s Liberation Army Joint Logistics Support Unit 967 Hospital.We used the CDSS integration system 2017 to evaluate whether there was DIC in the newly diagnosed APL patients,and to analyze the relevant influencing factors of DIC in the newly diagnosed APL patients,so as to achieve the purpose of early detection,timely diagnosis and treatment of the disease,stop the occurrence and development of DIC as much as possible,and improve the clinical quality of APL patients The mortality rate and prognosis provide useful reference.Methods 1.To collect the clinical case data of newly treated APL patients in the Hematology Department of Chinese People’s Liberation Army Joint Logistics Support Unit 967 Hospital from June 1998 to August 2012,so as to ensure that all the patients in the group meet the inclusion and exclusion criteria set by the subject.2.CDSS score system was used to evaluate 85 patients to determine whether they were combined with DIC.3.The subjects were divided into two groups: DIC(﹢)group and DIC(﹣)group.The clinical data of the two groups included sex,age,bleeding and bleeding site,fever /infection,blood routine,risk stratification,proportion of peripheral blood primordial cells,degree of bone marrow hyperplasia,number of bone marrow promyelocytes,coagulation and D-dimer,liver and kidney function,cytogenetics,inducement Guide the treatment of remission program.4.SPSS 21.0 statistical software was used for data analysis.T-test,U-test and X2 test were used,and the selected influencing factors were included in binary logistic regression analysis.The difference was statistically significant(P<0.05).Results 1.A total of 85 APL patients met the inclusion criteria and were divided into two groups: DIC(﹢)group(37 cases,43.5%)and DIC(﹣)group(48 cases,56.5%).2.Comparing the general condition of patients in DIC(﹢)group and DIC(﹣)group,the former had a higher bleeding rate than the latter,and DIC(﹢)group had more severe bleeding symptoms than DIC(﹣)group(P<0.05).The bleeding sites of the two groups of patients were counted,and the bleeding sites were mostly found in the skin and mucosa.There was no statistically significant difference in gender,age,fever / infection ratio between the two groups(P>0.05).3.Comparing the blood routine conditions of the patients in the DIC(﹢)group with those in the DIC(﹣)group,the WBC count,the proportion of peripheral blood primitive cells,and the risk stratification of the former at the first diagnosis were stratified as the incidence of high-risk patients.However,the PLT count at the initial diagnosis and the time required for WBC to reach the peak were lower than those in the DIC(﹣)group.The difference between the two groups was statistically significant(P<0.05).There was no statistically significant difference in Hb,Hb minimum value,and PLT minimum value between the two groups(P>0.05).4.Comparing the bone marrow morphology of the patients in the DIC(﹢)group with the DIC(﹣)group,the former had more active bone marrow hyperplasia than the latter,and the ratio of promyelocytes of the bone marrow was higher than the latter.Significance(P<0.05).5.Comparing the cytogenetics of the patients in the DIC(﹢)group with the DIC(﹣)group,the incidence of additional chromosomal abnormalities in the two groups was 10.34 %(3/29 cases)and 13.95 %(6/43 cases).The incidences of t(15;17)abnormalities were 89.66%(26/29 cases)and 86.05%(37/43 cases).There was no statistically difference between the two groups(P>0.05).6.Comparing the liver and kidney function of patients in DIC(﹢)group and DIC(﹣)group.Total protein(TP),albumin(ALB),globulin(GLB),total bilirubin(TBIL),Direct bilirubin(DBIL),indirect bilirubin(IBIL),aspartate aminotransferase(AST),alanine aminotransferase(ALT),blood urea nitrogen(BUN),blood creatinine(Scr) levels were not significantly different,no statistics Academic significance(P>0.05).7.Comparing DIC(﹢)group and DIC(﹣)group patients with induction remission treatment program,DIC(﹢)group patients were treated with RIF single induction treatment regimen orally in 29 cases,accounting for 78.38%,DIC(﹣)group 38 cases,accounting for 79.17%;8 patients in the DIC(﹢)group used RIF + ATRA dual induction therapy,accounting for 21.62%,and 10 patients in the DIC(﹢)group,accounting for 20.83%.The difference between these two treatments has no statistical difference on whether patients have DIC(P>0.05).8.Multivariate analysis showed that high WBC count and high-risk stratification were independent risk factors for APL complicated with DIC.Conclusion 1.After 85 patients with newly diagnosed APL were evaluated with the CDSS score system,37 patients in the DIC(﹢)group accounted for 43.5%(37/85 cases);48 patients in the DIC(﹣)group accounted for 56.5%(48/85 cases).2.Univariate analysis suggested: high bleeding rate,high WBC count,low PLT count,high peripheral blood blast cell ratio,risk stratification to high risk,high WBC peak,short time required to reach WBC,and active bone marrow hyperplasia at initial diagnosis The high proportion of promyelocytic cells in high bone marrow may be a potential risk factor for APL complicated with DIC.3.Multivariate analysis suggested that high WBC and risk stratification as high risk were independent risk factors for APL complicated with DIC.