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目的:分析我国老年急性髓系白血病(AML)的临床、生物学特点,疗效及预后,为临床诊治提供参考。方法:回顾性分析1995年4月-2008年2月收住院诊治的AML患者共167例,采用FAB及MICM分型诊断标准确诊。运用SPSS15.0软件进行统计学分析。率的比较采用χ2检验,生存分析采用生命表法及Kaplan-Meier法,不同组别的差异采用log-rank法检验。采用Cox回归分析影响生存的预后因素。结果:①我国老年AML以M2(M2a)、M5为主,染色体核型预后良好组比例低,并发慢性疾病较多,具有多种不良的预后因素。②58例接受标准“3+7”方案诱导化疗的非M3患者完全缓解(CR)率达70.7%,中位总生存(OS)期为6.8(0.6~100.2)个月。41例CR患者中位无病生存(DFS)期为5.2(0.2~99.0)个月。1年DFS概率为41%,1年OS概率为51%。早期死亡率12.9%。③分析细胞生物学特征与疗效的关系,发现前驱血液病史、骨髓病态造血及染色体核型对CR率的影响具有统计学意义。结论:我国老年AML以M2(M2a)、M5为主,具有多种不良的预后因素。部分患者可受益于强诱导化疗。影响疗效的主要因素有染色体核型、前驱血液病史和骨髓病态造血。
Objective: To analyze the clinical, biological characteristics, curative effect and prognosis of acute myeloid leukemia (AML) in our country and provide references for clinical diagnosis and treatment. Methods: A total of 167 AML patients admitted to our hospital from April 1995 to February 2008 were retrospectively analyzed. FAB and MICM were used to diagnose AML patients. Using SPSS15.0 software for statistical analysis. Rate comparison using χ2 test, survival analysis using life table method and Kaplan-Meier method, the differences between different groups using log-rank test. Cox regression analysis was used to analyze the prognostic factors affecting survival. Results: (1) The majority of AML patients in our country are M2 (M2a) and M5, with a low proportion of patients with good prognosis in karyotype. There are many chronic diseases and many adverse prognostic factors. ② The complete remission (CR) rate was 70.7% in the 58 non-M3 patients receiving standard “3 + 7” chemotherapy-induced chemotherapy and the median overall OS was 6.8 (0.6-100.2) months. The median disease-free survival (DFS) in 41 CR patients was 5.2 (range, 0.2 to 99.0) months. The 1-year DFS probability is 41% and the 1-year OS probability is 51%. Early mortality rate of 12.9%. The relationship between the biological characteristics of the cells and the curative effect was analyzed. It was found that the influence of the history of prodromal blood, morbid hematopoiesis and chromosomal karyotype on CR rate was statistically significant. Conclusion: AML in our country mainly consists of M2 (M2a) and M5, which have many unfavorable prognostic factors. Some patients can benefit from strong induction chemotherapy. The main factors affecting the efficacy of chromosome karyotype, a history of pre-blood and bone marrow morbid hematopoiesis.