摘要
目的 观察急性早幼粒细胞白血病 (APL)患者发病时、全反式维甲酸 (ATRA)和三氧化二砷(As2 O3 )治疗期间的止、凝血改变。方法 运用ELISA或发色底物法对 2 3例APL患者血浆一系列止、凝血指标进行动态检测。结果 治疗前血浆血栓调节蛋白 (TM )、血小板α颗粒膜蛋白 (GMP 140 )、可溶性纤维蛋白单体复合物、组织因子途径抑制物、组织纤溶酶原激活物活性 (t PA)和D 二聚体较正常组显著升高 ;纤维蛋白原、蛋白C(PC)抗原、纤溶酶原、α2 抗纤溶酶和纤溶酶原激活抑制物低于正常 ;PC活性 (PC∶A)和蛋白S抗原与正常组无显著差异。TM和GMP 140与患者发病时白细胞计数有关。ATRA及As2 O3 治疗缓解后除PC∶A部分增高外余均恢复至正常范围内。ATRA组TM、PC∶A和t PA有所升高 ,在As2 O3 组未发现上述现象。结论 APL发病过程中存在血管内皮细胞损伤、血小板活化以及凝血、抗凝、纤溶系统的激活 ,ATRA和As2 O3 治疗早期即能明显改善APL的止。
Objective To study the hemostatic changes during all trans retinoic acid (ATRA) or arsenic trioxide (As 2O 3) in acute promyelocytic leukemia (APL) patients. Methods The plasmic parameters were measured by ELISA or chromogenic study. Results Before treatmant the plasma level of thrombomodulin (TM), platelet α granular membrane protein 140(GMP 140), soluble fibrinomonomer complex, tissue factor pathway inhibitor, tissue plasminogen activator and D dimer all increased significantly whereas fibrinogen, antigen level of protein C, plasminogen, α2 plasminogen inhibitor and plasminogen activating inhibitor decreased but were restored to normal after complete remission, except protein C activity and protein S remained elevated in the ATRA group. In the ATRA group, the level of TM, PC∶A and t PA, were elevated although these were not found in As 2O 3 group. Conclusion There are pre sence of injury of vascular endothelium, activation of platelets and consumption of anticoagulants as well as activation of coagulation and fibrinolytic system in APL, which can be greatly improved during early stage of ATRA or As 2O 3 treatment.(Shanghai Med J, 2000,23∶349 353)
出处
《上海医学》
CAS
CSCD
北大核心
2000年第6期349-353,共5页
Shanghai Medical Journal
基金
上海血液学研究所胡应洲基金
关键词
急性早幼粒细胞白血病
维甲酸
砷剂
止血
凝血
Acute promyelocytic leukemia
All trans retinoic acid
Arsenic trioxide
Hemostasis
