Abstract:

Abstract：Objective　To explore the cause of death ，the time of death and the related factors in the children with acute leukemia. Methods　Retrospectively analyze the clinical information of the 64 dead cases of AL who were admitted to  our hospital from January 2000 to June 2009. Results　The time from diagnosis to death was 1 day to 50 months；34 cases died in 1 month （early death） （53.1%），18 cases within 6 months（28.1%），12 cases more than 6 months（18.8%）.  Infection-related deaths occurred in 45 case（70.3%），of which 25 cases died from respiratory tract infection（55.6%），4 cases from gastrointestinal infection and 4 septicemia ，2 cases skin infections，1 case urinary tract infection and 1 otitis media； recurrence-related deaths occurred in 29 cases，of which 14 died from with bone marrow relapse and 15 from marrow foreign recurrence，11 cases intracranial infiltration or recurrence，2 cases lung and testicular recurrence； bleeding-related deaths occurred in 26 cases，of which 16 cases died from intracranial hemorrhage and 7 cases from disseminated intravascular  oagulation（DIC），2 cases pulmonary hemorrhage and 1 gastrointestinal bleeding； chemotherapy-related side effects happened in 2 cases，1 case had pancreatitis and 1 renal failure. Analysis showed infection was the first place among the death causes （P < 0.05）. Multiple factors analysis showed boys，infants，children at high risk，high white blood cells and organ infiltration at first diagnosis had relations with AL death（P < 0.05）. Multiple factors analysis also showed infants，high white blood cell，high-risk children，high lactate dehydrogenase （LDH ） levels and M3 patients had relation with early death（P < 0.05）. Conclusion　The death of AL in children occurs mainly in remission induction. Causes of death are the infection as the first，followed by disease recurrence，bleeding and drug toxicity； boys，infants， children at high risk，high white blood cell anemia and organ infiltration at first diagnosis have relation with AL death. Infants，high white blood cell anemia，high-risk children and high LDH levels have relation with AL early death.

Key words: leukemia, acute, death, child

摘要：

摘要：目的　探讨儿童急性白血病（AL）在院死亡原因、时间及其相关因素。方法　回顾性分析华中科技大学同济医学院附属同济医院2000年1月至2009年6月收治的64例在院死亡AL患儿病例资料。 结果　从确诊到死亡的时间为1 d至50个月，34例（53.1%）于确诊1个月内死亡（早期死亡），18例于1～6个月内死亡（28.1%），12例 > 6个月死亡（18.8%）。与感染相关死亡45例（70.3%），其中呼吸道感染25例，败血症8例，消化道感染及不明部位感染各4例，皮肤感染2例，泌尿系感染及中耳炎各1例；疾病本身复发死亡29例（45.3%），其中骨髓复发14例，髓外复发15例，包括颅内浸润或复发11例，肺及睾丸复发各2例；与出血相关死亡26例（40.6%），其中颅内出血16例，弥散性血管内凝血（DIC）7例，肺出血2例，消化道出血1例；化疗相关副反应死亡2例，其中胰腺炎、肾衰竭各1例。感染占死亡原因首位，差异有统计学意义（P < 0.05）；死亡相关多因素分析示，初诊时男童、婴儿、高危患儿、高白细胞血症、有器官浸润与AL死亡相关（P <0.05）；早期死亡多因素分析示，婴儿、高白细胞血症、高危患儿、高乳酸脱氢酶（LDH）水平与AL早期死亡相关（P < 0.05）。结论　AL患儿死亡主要发生于诱导缓解期；死亡原因中感染占首位，其次为疾病复发、出血、药物毒性；初诊时男童、婴儿、高危患儿、高白细胞血症、有器官浸润与AL死亡相关；初诊时婴儿、高白细胞血症、高危患儿、高LDH水平、M3患儿与AL早期死亡相关。

关键词: 白血病, 急性, 死亡, 儿童