凝血酶－抗凝血酶_Ⅲ复合物和D－二聚体测定在急性白血病凝血障碍中的诊断价值

DIAGNOSTIC VALUE OF DETERMINA TIONS OF THROMBIN-ANTITGROMBIN_Ⅲ(TAT)COMPLEX AND D-DIMER IN COAGUL OPATHIES OF ACUTE LEUKEMIA

用单抗酶联免疫法和乳胶凝集法分别测定７例急性白血病患者凝血障碍过程中血浆凝血酶－抗凝血酶＿Ⅲ（ＴＡＴ）复合物和Ｄ－二聚体水平，并将３２份测试标本分为ＤＩＣ、无ＤＩＣ和肝损害组做比较。ＴＡＴ复合物总的和在３个组中的水平均明显增加（Ｐ分别＜０．０１），ＤＩＣ与无ＤＩＣ组间差异不显著（Ｐ＞０．０５）。Ｄ－二聚体总的和在ＤＩＣ和无ＤＩＣ组中的水平均明显增加（Ｐ分别＜０．０１），３组间差异显著（Ｐ分别＜０．０１）。在一些指标的相关性分析中，ＴＡＴ复合物和Ｄ－二聚体相关不明显（γ＝－０．１５，Ｐ＞０．０５），ＴＡＴ复合物和ＡＴ＿Ⅲ呈明显正相关（γ＝０．５２，Ｐ＜０．０１），Ｄ－二聚体和纤维蛋白原／纤维蛋白降解产物（ＦＤＰｓ）亦呈明显正相关（γ＝０．６０，Ｐ＜０．０１）。这一初步结果提示：在ＡＬ凝血障碍中，ＴＡＴ复合物是凝血系统激活的敏感指标，但可能易受外源或内源ＡＴ＿Ⅲ的影响；Ｄ－二聚体是继发性纤溶的敏感和特异性指标，其明显增加意味着ＤＩＣ的存在。

Plasma thrombin-antithrombin_Ⅲ (TAT )complex and D-dimer levels were mea-sured separately by using enzyme-linked immunosorbent assay and latex agglutination with monoclonal antibodies during the coagulopathies of 7 cases with acute leukemia AL).32 test samples were divided into DIC, non-DIC and liver damage groups for com-parison. The levels of TAT complex in the total samples and 3 groups increased marked-ly,(P<0. 01 respectively) ,The difference between DIC and non-DIC groups was not sig-nificant(P>0. 05).The levels of D-dimer in the total samples and in DIC and non-DIC groups also increased markedly(P<0. 01 respectively).The differences among 3 groups were very significant(P<0. 01 respectively).In the correlation analysis of some parame- ters ,there was no significant correlation between TAT complex and D-dimer(γ=0.15,P>0. 05);while there were positive correlations between TAT complex and AT_Ⅲ(γ=0. 52 ,P<0. 01),and D-dimer and fibrinogen/-fibrin degradation products(FDPs)(γ=0. 60 ,P<0.01).These preliminary results indicate that in coagulopathies of AL , TATcomplex is a sensitive indicator for activation of coagulation system,but may be influencedeasily by exogenous or endogenous AT|Ⅲ.D-dimer is both a sensitive and specific indicatorfor secondary fibrinolysis. And its marked increase implying the existence of DIC.