中文摘要：

目的：探讨初发急性早幼粒细胞白血病（APL）患者接受ATRA＋ATO±化疗早期死亡的危险因素。方法：本研究回顾性分析417例初治成人APL患者,比较早期死亡与非早期死亡的患者在临床表现、白细胞计数、血小板计数、凝血指标、骨髓细胞形态学、免疫学等检查方面是否存在差异。结果：417例患者中早期死亡36例,早期死亡率为8.6%。低、中、高危患者相应组别早期死亡率分别为1.9%,8.1%,16.2%（P=0.001）。出血引起的死亡21例,心脏功能衰竭和严重肺部感染各5例,维甲酸综合征3例,脑梗死1例,还有1例原因不明。多因素分析提示,患者起病时的美国东部肿瘤协作组（ECOG）评分、危险分层、出血症状和纤维蛋白原水平是早期死亡的独立危险因素（P值分别为P〈0.001,P=0.007,0.031和0.022）。结论：出血,尤其是颅内出血是APL早期死亡最为常见的原因。患者起病时的体能状态、危险分层、出血症状和纤维蛋白原水平是APL早期死亡的独立危险因素。

英文摘要：

Objective：To explore the risk factors of early death for acute promyelocytic leukemia （APL） patients receiving the treatment of ali-trans retinoic acid （ATRA）,arsenic trioxide （ATO） with or without chemotherapy. Method：We retrospectively analyzed 417 adult patients with newly diagnosed APL, and compared the clinical manifestations, white blood cell and platelet count, coagulatory index, bone marrow morphology and immunology between early death and non-early-death patients. Result：Thirty-six out of the 417 patients suffered from early death. The early death rate was 8.6%. For low-, intermediate- and high-risk patients the early death rates were 1.9 %, 8.1% and 16.2 %, respectively （P = 0. 001）. Twenty-one cases suffered from hemorrhage, 5 from cardiac failure,5 from severe pneumonia,3 with retinoic syndrome,1 from cerebral infarction and the other one was unclear. Multivariate analysis showed that the onset ECOG score, risk stratification,hemorrhage and fibrinogen level were the independent risk factors of early death （P〈0. 001, P = 0. 007,0. 031 and 0. 022, respectively）. Conclusion：Hemorrhage, especially cerebral hemorrhage, is the most common reason for early death in APL patients. The onset ECOG score,risk stratification, hemorrhage and fibrinogen level are the independent risk factors associated with early death of APL.