本文選題：白血病 + 年齡��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的:通過對四平市某醫(yī)院2010年01月至2014年12月期間確診的126例白血病患者進(jìn)行回顧性研究,分析白血病患者初診時的基本情況和臨床特征,包括白血病類型、性別構(gòu)成、年齡構(gòu)成、職業(yè)構(gòu)成以及實(shí)驗(yàn)室檢查改變等,并與文獻(xiàn)報道的白血病的臨床特征進(jìn)行比較,掌握四平市某醫(yī)院白血病患者的臨床特征,為白血病的防治提供理論依據(jù),從而更好地指導(dǎo)臨床工作。方法:通過醫(yī)院電子病歷綜合管理系統(tǒng),檢索并調(diào)閱2010年01月至2014年12月期間在四平市某醫(yī)院初診的白血病患者病例,根據(jù)設(shè)計個案調(diào)查表收集病歷資料進(jìn)行回顧性分析。研究內(nèi)容包括患者性別、發(fā)病年齡、職業(yè)、白血病類型、初診時的臨床表現(xiàn)及外周血檢查結(jié)果。采用血細(xì)胞分析儀檢測外周血WBC、Hb和PLT。取患者初次診斷為白血病未進(jìn)行治療時的血細(xì)胞分析結(jié)果進(jìn)行統(tǒng)計。根據(jù)《血液病診斷及療效標(biāo)準(zhǔn)》進(jìn)行白血病的診斷。本研究采用雙人錄入法,將收集到的病歷資料錄入EXCEL數(shù)據(jù)庫,利用SAS統(tǒng)計學(xué)軟件進(jìn)行數(shù)據(jù)分析。結(jié)果:1.126例初治白血病患者中,男64例,女62例,男:女=l.03:1。最小年齡為4歲,最大年齡為80歲,中位年齡為49歲;14歲以下的有13例,占10.32%,15-39歲的有30例,占23.02%,40歲以上發(fā)病的有84例,占66.66%。81例ANLL患者中,14歲以下的有4例,占4.94%,15-39歲的有21例,占25.93%,40歲以上發(fā)病的有56例,占69.14%。所占比重較大的兩個年齡段分別為40-49歲和大于60歲。126例初治白血病患者的職業(yè)包括干部、農(nóng)民、教師、學(xué)生、工人和未知職業(yè),其中農(nóng)民最多58例,占46.03%,其次為未知職業(yè)和工人,分別占21.43%和15.87%。同樣,在81例初治ANLL患者中,農(nóng)民所占比例也是最高,為50.62%,其次為未知職業(yè)者和工人,分別占20.99%和14.81%。2.126例初治白血病患者中,包括ALL、ANLL、CLL和CML四種類型,其中以ANLL最多為81例,占64.29%,其次為ALL,25例,占19.84%,CLL和CML分別為5例和15例,占3.97%和11.90%。81例ANLL患者類型包括M1、M2、M3、M4、M5和M6,未見M0、M7型患者,而且以M2、M3型患者居多,分別占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臨床癥狀為乏力,發(fā)熱、出血和淋巴結(jié)腫大。有83.33%的患者就診時有乏力,有55.56%的患者就診時有發(fā)熱,有35.71%的患者就診時有出血癥狀,有36.51%的患者就診時有淋巴結(jié)腫大,有17.46%的患者就診時有脾腫大和食欲下降,有14.29%的患者就診時有腹脹,有15.08%的患者就診時有牙齦腫痛,僅有8.73%的患者出現(xiàn)骨痛,只有4.76%的患者有肝腫大和消瘦。81例初治ANLL患者中,有87.65%的患者就診時有乏力,有51.85%的患者就診時有發(fā)熱,有37.04%的患者就診時有出血癥狀,有29.63%的患者就診時有淋巴結(jié)腫大,有19.75%的患者就診時有食欲下降,有18.52%的患者就診時有牙齦腫痛,有12.35%的患者就診時有腹脹,有9.88%的患者就診時有脾腫大,僅有4.94%的患者出現(xiàn)骨關(guān)節(jié)痛,只有2.47%的患者有肝腫大和盜汗。4.126例白血病患者初診時外周血白細(xì)胞計數(shù)低于正常值者占21.47%,最低值為0.3×109/L,高于正常值者占68.25%,最高值為470.0×109/L,其中37.5%白血病患者白細(xì)胞數(shù)高于50×109/L;126例白血病患者初診時中性粒細(xì)胞異常占78.58%,低于0.5×109/L者占16.67%。白血病患者性別和年齡與外周血白細(xì)胞變化之間經(jīng)統(tǒng)計學(xué)檢驗(yàn)無顯著性差異(p0.05)。ANLL患者初診時外周血白細(xì)胞計數(shù)低于正常值者占30.86%,最低值為0.3×109/L,高于正常值者占56.80%,最高值為285.0×109/L,其中28.40%白血病患者白細(xì)胞數(shù)高于50×109/L;ANLL患者初診時中性粒細(xì)胞異常占82.72%,低于0.5×109/L者占18.52%。126例白血病患者初診時外周血血紅蛋白只有10.32%正常,異常者達(dá)到89.68%,血紅蛋白最低為33g/L,而且白血病患者初診時以中度貧血為主,占40.48%,輕度和重度貧血分別占29.32%和19.84%。白血病患者性別和年齡與貧血程度之間經(jīng)統(tǒng)計學(xué)檢驗(yàn)無顯著性差異(p0.05)。81例ANLL患者初診時外周血血紅蛋白只有6.17%正常,異常者達(dá)到93.83%,血紅蛋白最低為33g/L,而且患者初診時以中度貧血為主,占40.74%,輕度和重度貧血分別占25.93%和27.16%。126例白血病患者初診時,只有17.46%的患者血小板正常,82.54%的患者血小板異常,其中75.40%的白血病患者存在血小板計數(shù)降低,最低值為6.0×109/L,高于300×109/L者占7.14%。白血病患者性別和年齡與外周血血小板變化之間經(jīng)統(tǒng)計學(xué)檢驗(yàn)無顯著性差異(p0.05)。81例ANLL患者初診時,血小板正�；颊咧挥�11.11%,88.89%的患者血小板異常,其中87.66%的ANLL患者存在血小板計數(shù)降低,最低值為6×109/L。結(jié)論:1.白血病患者的發(fā)病率男性略多于女性;發(fā)病高峰的兩個年齡段分別為50-59歲和大于60歲;職業(yè)以農(nóng)民和工人居多;白血病類型中以A NLL多見;ANLL中以M2多見。2.白血病患者初診時臨床癥狀以乏力、出血、發(fā)熱和淋巴結(jié)腫大多見,貧血以中度貧血居多。3.白血病患者初診時白細(xì)胞和中性粒細(xì)胞大多數(shù)出現(xiàn)異常,白細(xì)胞以增高為主,中性粒細(xì)胞以減少為主;絕大多數(shù)患者出現(xiàn)血紅蛋白和血小板的降低,年齡和性別對外周血變化沒有影響。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R733.7

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