血液系统恶性肿瘤并发肿瘤溶解综合征的临床特征和影响因素

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摘要

目的探讨血液系统恶性肿瘤患者并发肿瘤溶解综合征（TLS）的发生率、临床特点及危险因素。方法回顾性分析2019年1月至2021年6月福建省立医院血液科收治的182 例血液系统恶性肿瘤患者的临床资料，分析患者TLS 的发生情况及其危险因素。结果 182 例患者中，28 例患者并发TLS，发生率15.4%。并发TSL 患者均出现血尿酸升高，血乳酸脱氢酶升高25 例（89.3%），高磷血症21 例（75.0%），低钙血症16 例（57.1%），尿素氮和肌酐升高9 例（32.1%），高钾血症7 例（25.0%）。单因素分析显示，年龄、白细胞计数、肿块直径、肌酐、尿酸、血清乳酸脱氢酶与并发TLS 相关（P＜0.05）。多因素logistic 分析显示，白细胞计数≥50×109/L（β=1.260，OR=3.500，P=0.012，95%CI：1.862～7.144）、肿块直径≥5 cm（β=0.094，OR=1.986，P=0.028，95%CI：1.357～6.553）、肌酐≥123 μmol/L（β=1.370，OR=3.742，P=0.011，95%CI：1.195～5.832）、尿酸≥476 μmol/L（β=0.071，OR=1.934，P=0.036，95%CI：1.580～4.748）、乳酸脱氢酶≥245 U/L（β=2.890，OR=6.843，P=0.009，95%CI：1.468～8.748）为独立危险因素。结论 TLS 是血液系统恶性肿瘤的常见严重并发症，治疗中应密切监测，警惕其危险因素，及时干预是非常必要的。

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关键词 ：肿瘤溶解综合征, 血液恶性肿瘤, 发病率, 危险因素

Abstract：

Objective To explore the incidence, clinical characteristics and risk factors of patients with tumor lysis syndrome(TLS)in patients with hematological malignancies.Methods The clinical data of 182 patients with hematological malignancies admitted to the Department of Hematology, Fujian Provincial Hospital from January 2019 to June 2021 were retrospectively analyzed, and the occurrence and risk factors of TLS were analyzed. Results Among 182 patients,28 patients were complicated with TLS, with an incidence of 15.4%. All patients with TSL had elevated serum uric acid,elevated serum lactate dehydrogenase(LDH)in 25 cases(89.3%),hyperphosphatemia in 21 cases(75.0%),hypocalcemia in 16 cases (57.1%), elevated urea nitrogen and creatinine in 9 cases (32.1%), and hyperkalemia in 7 cases (25.0%).Univariate analysis showed that age, white blood cell count, mass diameter, creatinine, uric acid and serum lactate dehydrogenase were associated with TLS (P＜0.05). Multivariate logistic analysis showed that white blood cell count≥50×109/L (β=1.260, OR=3.500, P=0.012, 95%CI: 1.862-7.144) and mass diameter ≥5 cm (β=0.094, OR=1.986, P=0.028, 95%CI: 1.357-6.553), creatinine ≥123 μmol/L (β=1.370, OR=3.742, P=0.011, 95%CI: 1.195-5.832), uric acid≥476 μmol/L (β=0.071, OR=1.934, P=0.036, 95%CI: 1.580-4.748) and lactate dehydrogenase ≥245 U/L (β=2.890,OR=6.843, P=0.009, 95%CI: 1.468-8.748) were independent risk factors. Conclusion TLS is a common and serious complication of hematological malignancies. It is necessary to closely monitor and guard against its risk factors during treatment.

Key words： Tumor lysis syndrome Hematological malignancies Instance Risk factors

通讯作者: 谢颖（1978-），女，福建泉州人，博士，副主任医师，研究方向：恶性血液病的诊治。

作者简介: 郑志海（1986-），男，福建莆田人，硕士，研究方向：恶性血液病的诊治。

引用本文:

郑志海；陈碧云；廖丽昇；曲双；谢颖. 血液系统恶性肿瘤并发肿瘤溶解综合征的临床特征和影响因素[J]. 中国当代医药, 2022, 29(26): 99-102.
ZHENG Zhihai CHEN Biyun LIAO Lisheng QU Shuang XIE Ying▲. Clinical characteristic and risk factors of hematological malignancies with tumor lysis syndrome. 中国当代医药, 2022, 29(26): 99-102.

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https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2022/V29/I26/99

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