四平市某医院126例初诊白血病病例分析

发布时间：2018-06-21 08:59

本文选题：白血病 + 年龄　；参考：《吉林大学》2015年硕士论文

【摘要】：目的:通过对四平市某医院2010年01月至2014年12月期间确诊的126例白血病患者进行回顾性研究,分析白血病患者初诊时的基本情况和临床特征,包括白血病类型、性别构成、年龄构成、职业构成以及实验室检查改变等,并与文献报道的白血病的临床特征进行比较,掌握四平市某医院白血病患者的临床特征,为白血病的防治提供理论依据,从而更好地指导临床工作。方法:通过医院电子病历综合管理系统,检索并调阅2010年01月至2014年12月期间在四平市某医院初诊的白血病患者病例,根据设计个案调查表收集病历资料进行回顾性分析。研究内容包括患者性别、发病年龄、职业、白血病类型、初诊时的临床表现及外周血检查结果。采用血细胞分析仪检测外周血WBC、Hb和PLT。取患者初次诊断为白血病未进行治疗时的血细胞分析结果进行统计。根据《血液病诊断及疗效标准》进行白血病的诊断。本研究采用双人录入法,将收集到的病历资料录入EXCEL数据库,利用SAS统计学软件进行数据分析。结果:1.126例初治白血病患者中,男64例,女62例,男:女=l.03:1。最小年龄为4岁,最大年龄为80岁,中位年龄为49岁;14岁以下的有13例,占10.32%,15-39岁的有30例,占23.02%,40岁以上发病的有84例,占66.66%。81例ANLL患者中,14岁以下的有4例,占4.94%,15-39岁的有21例,占25.93%,40岁以上发病的有56例,占69.14%。所占比重较大的两个年龄段分别为40-49岁和大于60岁。126例初治白血病患者的职业包括干部、农民、教师、学生、工人和未知职业,其中农民最多58例,占46.03%,其次为未知职业和工人,分别占21.43%和15.87%。同样,在81例初治ANLL患者中,农民所占比例也是最高,为50.62%,其次为未知职业者和工人,分别占20.99%和14.81%。2.126例初治白血病患者中,包括ALL、ANLL、CLL和CML四种类型,其中以ANLL最多为81例,占64.29%,其次为ALL,25例,占19.84%,CLL和CML分别为5例和15例,占3.97%和11.90%。81例ANLL患者类型包括M1、M2、M3、M4、M5和M6,未见M0、M7型患者,而且以M2、M3型患者居多,分别占36.5%和28.3%,其余患者占37.03%。3.126例初治白血病患者最主要的临床症状为乏力,发热、出血和淋巴结肿大。有83.33%的患者就诊时有乏力,有55.56%的患者就诊时有发热,有35.71%的患者就诊时有出血症状,有36.51%的患者就诊时有淋巴结肿大,有17.46%的患者就诊时有脾肿大和食欲下降,有14.29%的患者就诊时有腹胀,有15.08%的患者就诊时有牙龈肿痛,仅有8.73%的患者出现骨痛,只有4.76%的患者有肝肿大和消瘦。81例初治ANLL患者中,有87.65%的患者就诊时有乏力,有51.85%的患者就诊时有发热,有37.04%的患者就诊时有出血症状,有29.63%的患者就诊时有淋巴结肿大,有19.75%的患者就诊时有食欲下降,有18.52%的患者就诊时有牙龈肿痛,有12.35%的患者就诊时有腹胀,有9.88%的患者就诊时有脾肿大,仅有4.94%的患者出现骨关节痛,只有2.47%的患者有肝肿大和盗汗。4.126例白血病患者初诊时外周血白细胞计数低于正常值者占21.47%,最低值为0.3×109/L,高于正常值者占68.25%,最高值为470.0×109/L,其中37.5%白血病患者白细胞数高于50×109/L;126例白血病患者初诊时中性粒细胞异常占78.58%,低于0.5×109/L者占16.67%。白血病患者性别和年龄与外周血白细胞变化之间经统计学检验无显著性差异(p0.05)。ANLL患者初诊时外周血白细胞计数低于正常值者占30.86%,最低值为0.3×109/L,高于正常值者占56.80%,最高值为285.0×109/L,其中28.40%白血病患者白细胞数高于50×109/L;ANLL患者初诊时中性粒细胞异常占82.72%,低于0.5×109/L者占18.52%。126例白血病患者初诊时外周血血红蛋白只有10.32%正常,异常者达到89.68%,血红蛋白最低为33g/L,而且白血病患者初诊时以中度贫血为主,占40.48%,轻度和重度贫血分别占29.32%和19.84%。白血病患者性别和年龄与贫血程度之间经统计学检验无显著性差异(p0.05)。81例ANLL患者初诊时外周血血红蛋白只有6.17%正常,异常者达到93.83%,血红蛋白最低为33g/L,而且患者初诊时以中度贫血为主,占40.74%,轻度和重度贫血分别占25.93%和27.16%。126例白血病患者初诊时,只有17.46%的患者血小板正常,82.54%的患者血小板异常,其中75.40%的白血病患者存在血小板计数降低,最低值为6.0×109/L,高于300×109/L者占7.14%。白血病患者性别和年龄与外周血血小板变化之间经统计学检验无显著性差异(p0.05)。81例ANLL患者初诊时,血小板正常患者只有11.11%,88.89%的患者血小板异常,其中87.66%的ANLL患者存在血小板计数降低,最低值为6×109/L。结论:1.白血病患者的发病率男性略多于女性;发病高峰的两个年龄段分别为50-59岁和大于60岁;职业以农民和工人居多;白血病类型中以A NLL多见;ANLL中以M2多见。2.白血病患者初诊时临床症状以乏力、出血、发热和淋巴结肿大多见,贫血以中度贫血居多。3.白血病患者初诊时白细胞和中性粒细胞大多数出现异常,白细胞以增高为主,中性粒细胞以减少为主;绝大多数患者出现血红蛋白和血小板的降低,年龄和性别对外周血变化没有影响。
[Abstract]:Objective: through a retrospective study of 126 cases of leukemia diagnosed from 01 months to December 2014 from 2010 to December 2014 in Siping City, the basic and clinical features of leukemia patients were analyzed, including the type of leukemia, the structure of sex, the age structure, the occupational composition and laboratory examination, and the white blood reported in the literature. The clinical characteristics of the disease were compared, the clinical characteristics of leukemia patients in Siping City were mastered, and the theoretical basis was provided for the prevention and treatment of leukemia. Thus, the clinical work was better guided. Methods: through the comprehensive management system of hospital electronic medical records, the leukemia was retrieved and reviewed in a hospital in Siping City from 01 to December 2014 2010. The patient's case, a retrospective analysis was collected according to the design case questionnaire. The study included the patient's sex, age, occupation, type of leukemia, clinical manifestation at first diagnosis, and the results of peripheral blood examination. The blood cell analyzer was used to detect the peripheral blood WBC, Hb and PLT. for the first diagnosis of leukemia when the leukemia was not treated. The results of blood cell analysis were made. According to the diagnosis of the blood disease diagnosis and the standard of curative effect, the diagnosis of leukemia was carried out in this study. The data of the medical records were recorded in the EXCEL database, and the data were analyzed by SAS statistics software. Results: among the 1.126 cases of primary white blood disease, 64 men, 62 women, male: female =l.03:1. most. The age is 4 years old, the maximum age is 80 years and the median age is 49 years old; 13 cases under 14 years of age, 10.32%, 15-39 years old, 30, 23.02%, and 40 years older than 84. In 66.66%.81 cases, there are 4 cases under 14 years old, accounted for 49 years old, accounting for more than 49 years old. The two age groups of 40-49 years old and 60 years old, respectively, included cadres, farmers, teachers, students, workers and unknown occupations, among which 58 were farmers, accounting for 46.03%, followed by unknown occupations and workers, accounting for 21.43% and 15.87%., respectively. Among 81 ANLL patients, the proportion of farmers was also the highest. 50.62%, followed by unknown occupations and workers, accounted for 20.99% and 14.81%.2.126 cases of primary leukemia, including four types of ALL, ANLL, CLL and CML, among which 81 were ANLL, 64.29%, followed by ALL, 25, 19.84%, CLL and CML in 5 and 15, 3.97% and 11.90%.81 ANLL. M6, no M0, type M7 patients, and the majority of patients with M2, M3, accounted for 36.5% and 28.3% respectively. The rest of the patients accounted for the most important clinical symptoms of leukemia patients in the initial treatment of leukemia: fatigue, fever, bleeding and lymph node swelling. 83.33% of the patients were tired at the time of treatment, 55.56% of the patients had fever during their visits, and 35.71% of the patients had a visit. Bleeding symptoms, 36.51% of patients with lymph node swelling, 17.46% of the patients have splenomegaly and loss of appetite, 14.29% of the patients have abdominal distention, 15.08% of the patients have gingival swelling and pain, only 8.73% of the patients have bone pain, only 4.76% of the patients have hepatomegaly and thin.81 cases of ANLL patients, 87. 51.85% of the patients had fever when they went to visit, and 51.85% of the patients had fever while 37.04% of the patients had bleeding symptoms. 29.63% of the patients had swollen lymph nodes, 19.75% of the patients had a decline in appetite, 18.52% of the patients had gingival swelling, 12.35% of the patients had abdominal distention, 9.88% of the patients. There were splenomegaly, only 4.94% of patients had osteoarthritis, only 2.47% of the patients had hepatomegaly and.4.126 cases of night sweating, and the peripheral blood leucocyte count was 21.47%, the lowest was 0.3 x 109/L, 68.25% and 470 x 109/L, and 37.5% leukocytes were leukocytes. The number was higher than 50 x 109/L; 126 cases of leukemia were first diagnosed with neutrophils (78.58%), less than 0.5 x 109/L accounted for no significant difference between the sex and age of 16.67%. leukemia and the changes of peripheral blood white blood cells (P0.05) the peripheral blood leucocyte count was lower than the normal value of 30.86% in the first diagnosis of.ANLL patients, and the lowest value was the lowest value. 0.3 x 109/L, higher than the normal value of 56.80%, the highest value of 285 x 109/L, the number of leukocytes in 28.40% leukemia patients was higher than 50 x 109/L; ANLL patients at first diagnosis of neutrophils accounted for 82.72%, lower than 0.5 x 109/L in the 18.52%.126 cases of leukemia patients at first diagnosis of peripheral blood erythroprotein only 10.32% normal, abnormal persons to 89.68%, blood red eggs The lowest White was 33g/L, and the primary anemia was mainly in the early diagnosis of leukemia, accounting for 40.48%. There was no significant difference between the sex and age of the patients with mild and severe anemia in 29.32% and the age of 19.84%. and the degree of anemia (P0.05). The peripheral blood hemoglobin of the patients with ANLL was only 6.17% normal at the initial diagnosis of ANLL. 93.83%, the lowest hemoglobin was 33g/L, and the patient was first diagnosed with moderate anemia, accounting for 40.74%. When mild and severe anemia accounted for 25.93% and 27.16%.126 cases with leukemia, only 17.46% of the patients had normal platelets and 82.54% of the patients with thrombocytopenia, and 75.40% of the leukemia patients had the lowest platelet count. There was no significant difference between the sex, age and peripheral blood platelets in patients with 7.14%. leukemia (6 * 109/L). There was no significant difference between the sex, age and peripheral blood platelet changes in patients with 7.14%. leukemia (P0.05). At the initial diagnosis of ANLL patients in.81 cases, only 11.11% and 88.89% of the patients with normal platelets were abnormal, and 87.66% of the ANLL patients had the lowest platelet count. The value of 6 x 109/L. conclusion: 1. the incidence of leukemia in patients with leukemia is slightly more than that of women; the two ages of the peak of the onset are 50-59 years and more than 60 years, the majority of the occupations are farmers and workers, and the type of leukemia is A NLL, and the clinical symptoms of.2. leukaemia patients with M2 in the initial diagnosis are weak, bleeding, fever and lymph node enlargement in the initial diagnosis of the patients with.2. leukemia. In the majority of patients with anemia with moderate anemia, most of.3. leukaemia patients were diagnosed with abnormal leukocyte and neutrophils, white blood cells were mainly increased, neutrophils were mainly reduced, most of the patients had hemoglobin and platelet reduction, age and sex had no effect on peripheral blood changes.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R733.7

【参考文献】