摘要
本研究旨在探讨初诊急性白血病(AL)(急性早幼粒细胞白血病除外)凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(FIB)、血浆凝血酶时间(TT)及D-二聚体(D-D)预测出血风险的临床意义,探究引起上述5项凝血指标异常的影响因素及相关性。回顾分析114例AL患者不同凝血指标异常情况下的出血情况,分析年龄、性别、白血病类型、白细胞及血小板计数、骨髓中原始细胞比例、细胞遗传学变化与凝血指标的关系。结果表明:初诊AL的凝血指标异常的发生率高达78.1%;凝血5项均正常的患者亦可能合并轻度出血;异常的凝血指标数量越多,出血程度越重;PT及D-D对其2级出血诊断具有一定敏感性;凝血异常发生率与初诊时骨髓中原始细胞的比例存在相关性(χ2=4.184,OR=1.021,P﹤0.05),与年龄、性别、白血病类型、白细胞及血小板计数、细胞遗传学异常无明显相关(P﹥0.05);起病时骨髓原始细胞比例与D-D值显著相关(r=0.3,P﹤0.01)。结论:AL患者的凝血指标异常的发生率高;异常的凝血指标越多,则出血程度越重,其中PT及D-D对2级出血诊断具有一定敏感性;起病时骨髓中原始细胞比例与凝血指标异常(尤其是D-D)存在显著相关性,而老年、高白细胞数及不良细胞遗传学异常与凝血异常无关;通过对PT、APTT、TT、FIB、D-D的监测,为临床判断及防治出血事件提供实验依据。
To explore hemorrhage risk and the clinical significance of abnormal change of prothrombin time （ PT）, activated partial thromboplastin time （APTT）, plasma fibrinogen （FIB）, plasma thrombin time （TT） and d-dimer （D- D） in de novo acute leukemia（ except for APL）, the different bleeding manifestations of 114 cases of de novo acute leu- kemia with different coagulation indexes were analyzed retrospectively. The correlation between these blood coagulation indexes and the possible correlative clinical characteristics were analysed, including age, sex, type of acute leukemia, initial white blood cell（WBC） and platelet（Pit） count, the proportion of blast cells in bone marrow and cytogenetic ab- normality of patients at diagnosis. The results indicated that the incidence of abnormal blood coagulation was as high as 78.1% for de novo AL patients. These patients with 5 normal blood coagulation indexes may have mild bleeding mani- festation, but the more abnormal indexes, the more severe bleeding. Both PT and D-D were sensitive indexes for diag- nosis of level II bleeding. Incidence of abnormal blood coagulation significantly correlates with the proportion of blast cells in bone marrow（χ2 =4. 184,OR=1.021,P 〈 0.05） and more with D-D （P 〈 0.01）, while age, sex, type of AL, WBC count, Pit count and abnormality of cytogenetics did not correlate with abnormal blood coagulation. It is con- cluded that the coagulation and fibrinolysis are abnormal in most patients with de novo acute leukemia. More abnormal indexes indicate more severe bleeding, and both PT and D-D are sensitive indexes for diagnosis of level II bleeding. Higher proportion of blast cells in bone marrow predicts higher incidence of abnormal blood clotting. Acute leukemia with elderly age, high white blood cell count and adverse cytogenetics do not predict severer abnormal blood clotting. Detection of PT,APTT,TT,FIB, and D-D may help to judge whether the patients are in a state of hypercoagnlability or disseminated intravenous coagulation, which will provide experiment evidences for early intervention and medication.
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2013年第2期300-304,共5页
Journal of Experimental Hematology
基金
首都医学发展科研基金(2009-3072)<非清髓造血干细胞移植治疗老年急性白血病的研究>
