急性白血病并发弥散性血管内凝血前相关因素及其临床意义

Study of related factors and clinical significance of pre-disseminated intravascular coagulation patients with acute leukemia.

目的探讨急性白血病并发弥散性血管内凝血(DIC)前的相关因素,以便早期诊断和积极预防DIC的发生.方法回顾性分析383例急性白血病患者的临床资料,其中确诊并发DIC 46例,将确诊DIC前3～5 d可能相关的17个因素与未发生DIC患者比较.结果外周血白细胞计数、M3在两组中所在比例差异显著(P＜0.01),D-二聚体含量、血浆组织因子、凝血酶-抗凝血酶复合物、纤溶酶-抗纤溶酶复合物、凝血酶原时间、活化部分凝血活酶时间6个因素两组间有显著差异(P＜0.05).血红蛋白、血小板、血脂、血糖、肌酐、血清乳酸脱氢酶及年龄、性别和体温等因素两组间无显著性差异.结论对白细胞计数升高及D-二聚体、血浆组织因子、凝血酶-抗凝血酶复合物、纤溶酶-抗纤溶酶复合物水平高,凝血酶原时间、活化部分凝血活酶时间缩短以及急性早幼粒细胞白血病等(M3)患者应注意弥散性血管内凝血的发生.

Objective To study the related factor and clinical significance of pre-disseminated intravascular coagulation patient with acute leukemia,and to diagnose earlier and actively prevent the occurrence of DIC.Methods Clinical data of 383 cases with acute leukemia were retrospectively analyzed.46 cases were final diagnosed with DIC.The possibility related factors 17 were collected in 3 to 5 days before final diagnosis with DIC.Corresponding data were collected in the group of patients without DIC.The date in two groups were analyzed.Results Quantity of leucocyte and the type of leukemia in two groups were different obviously (P<0.01).The contents of D-D,TF,TAT,PAP,PT,APTT were different significantly in two groups(P<0.05).But the levels of Hb,BPC,TC.TG,Glu,Cr,sLDH,body temperature,age structure and sex in two groups were not different significantly between groups.Conclusion Attention should be paid to the tendency of DIC in patients with high quantity of leucocyte in blood,and contents of D-D,TF,TAT,PAP,and with shorter PT,APTT and the patients with acute promyelocytic leukemia(APL).