重症监护病房噬血细胞淋巴组织细胞增生症临床分析

摘要

目的：观察噬血细胞淋巴组织细胞增生症(HLH)患者早期死亡的危险因素。方法：收治重症监护病房(ICU) HLH 患者71例，单因素和多因素分析28 d 死亡率及危险因素。结果：28 d 总体死亡率和住院死亡率分别为38%和68%，与增加28 d死亡率相关的危险因素包括序贯性器官功能衰竭(ICU计分，P＜0.001)和年龄增长(P=0.03)。与增加住院死亡率相关的因素为ICU住院计分高风险的序贯性器官衰竭(P＜0.01)、年龄增长(P=0.04)、淋巴瘤样HLH或不明原因的HLH(P＜0.01)。结论：器官衰竭是ICU中成人HLH患者早期死亡危险因素中的最重要的原因，采用早期特定的细胞毒性治疗、控制基础疾病，可能会阻止器官衰竭和早期死亡的发生。%Objective:To observe the risk factors of early death of patients with hemophagocytic lymphohistiocytosis(HLH). Methods:71 patients with HLH were selected in the intensive care unit.The 28 days mortality rate and risk factors were analyzed by univariate and multivariate.Results:The 28 days totality mortality rate and hospitalized mortality rate were respectively 38%and 68%.The relevant risk factors of increasing 28 days mortality rate included sequential organ failure(ICU scoring,P<0.001) and age increasing(P=0.03).The relevant risk factors of increasing hospitalized mortality rate were ICU admission score high-risk sequential organ failure(P<0.01),age increasing(P=0.04),lymphoma sample HLH or unexplained HLH(P<0.01).Conclusion:Organ failure is the most important reason in early death risk factors of adult ICU HLH patients.Using early specific cytotoxic treatment,controling basic diseases may prevent the occurrence of organ failure and early death.