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目的探讨恶性血液病患者化疗后出血的与白细胞和血小板计数的关系。方法观察96例恶性血液病化疗后的临床出血情况,监测出血时血小板计数、化疗前白细胞计数。比较不同年龄组、性别、疾病缓解状态的出血发生率;分析出血程度与血小板减少程度、白细胞计数的关系。结果 96例恶性血液病患者化疗后出血28例(ALL4例,AML(非M3型)16例,NHL1例,MM2例,HL1例,MDS4例),出血发生率为29.2%;≥55岁组出血发生率为44.2%(23/52),明显高于<55岁组(11.4%,5/44)(χ~2=12.462,P<0.05),而不同性别患者化疗后出血发生率的差异无统计学意义(P>0.05)。缓解组患者化疗后出血发生率为15.21%;未缓解组患者出血发生率为42.0%,较缓解组患者出血发生率高(χ~2=8.318,P<0.05)。出血患者均有血小板减少,1-2级出血组和3-4级出血组患者的血小板减少程度的差异有统计学意义(χ~2=13.38,P<0.01)。白细胞计数≥50×109/L的急性白血病患者出血患者3-4级的出血发生率高于白细胞计数<50×109/L的患者,差异有统计学意义(χ~2=6.806,P<0.05)。结论年龄≥55岁、恶性血液病未缓解可能为出血的危险因素;白细胞计数≥50×109/L可能为急性白血病患者3-4级出血的危险因素;血小板减少与恶性血液病患者出血相关,血小板<20×109/L时出血发生率明显增加。
Objective To investigate the relationship between leukopenia and platelet count in patients with hematologic malignancies after chemotherapy. Methods The clinical bleeding of 96 patients with malignant hematologic disease was observed. The hemorrhage platelet count and the leucocyte count before chemotherapy were monitored. The incidence of hemorrhage was compared between different age groups, sex and disease state. The relationship between hemorrhage and thrombocytopenia and white blood cell count was analyzed. Results A total of 96 patients with hematologic malignancies had hemorrhage after chemotherapy, 28 (ALL 4, AML 16, NHL 1, MM 2, HL 1 and MDS 4). The bleeding rate was 29.2% The incidence of hemorrhage after chemotherapy was 44.2% (23/52), significantly higher than that of 55 years old (11.4%, 5/44) (χ ~ 2 = 12.462, P <0.05) Statistical significance (P> 0.05). The rate of hemorrhage after chemotherapy in remission group was 15.21%. The rate of hemorrhage in non-remission group was 42.0%, which was higher than that in remission group (χ ~ 2 = 8.318, P <0.05). Thrombocytopenia was found in all the patients with hemorrhage. There was significant difference in thrombocytopenia in grade 1-2 and grade 3-4 bleeding patients (χ ~ 2 = 13.38, P <0.01). The grade 3-4 hemorrhage rate in patients with acute leukemia with leucocyte count ≥50 × 109 / L was higher than that in patients with leucocyte count <50 × 109 / L (χ ~ 2 = 6.806, P <0.05 ). CONCLUSIONS: Aged ≥ 55 years old, hematologic malignancy may not be a risk factor for bleeding; leukocyte count ≥50 × 109 / L may be a risk factor for grade 3-4 hemorrhage in patients with acute leukemia; thrombocytopenia is associated with bleeding in patients with hematologic malignancies, Platelet count <20 × 109 / L significantly increased the incidence of bleeding.