儿童急性淋巴细胞白血病诱导化疗前凝血指标改变意义探讨

The significance of the indications of coagulation before induction chemotherapy in children with acute lymphoblastic leukemia

目的分析儿童急性淋巴细胞白血病诱导化疗前凝血指标改变及相关因素,指导治疗、减少并发症发生。方法检测北京儿童医院血液病中心一病房2004年收治的初发急性淋巴细胞白血病63例病人的诱导化疗前凝血指标、免疫分型、临床指标及诱导治疗早期(2周内)并发症,分析它们之间关系。结果有30例(47.6%)病人化疗前有凝血指标改变:1、与临床出血表现、血小板减少无明显关系(P>0.05),2、与白细胞增多、肾脏浸润、谷草转氨酶/尿酸升高无明显关系(P>0.05)、与组织肿瘤负荷大、乳酸脱氢酶上升有明显关系(P<0.05);与免疫分型T细胞型有明显关系;与危险度无明显关系(P>0.05)。3、诱导化疗前凝血指标异常与诱导化疗2周内出现的与DIC发生倾向有明显关系(P<0.01),与高尿酸血症、肾功能不全无明显关系(P>0.05)。结论儿童急性淋巴细胞白血病诱导化疗前可有凝血指标改变,1、临床出血表现、血小板数量并不能反映、替代凝血指标改变,2、发生凝血指标改变的高危因素可能有高肿瘤负荷、高LDH、T细胞型白血病,3、凝血指标的改变提示了诱导化疗2周内DIC发生的可能性。因此要重视其变化,积极纠正,是减少临床相关并发症的有效方法。

Objective To analyse the significance of the coagulation indications before induction chemotherapy in children with acute lymphoblastic leukemia （ALL）, help the treatment and induce the complications after chemotherapy. Methods To test prospectively the coagulation indications in the new ALL childhood patients, analyse tile relation with immunophenotype, clinical manifestations and the complications during 2 weeks after induction chemotherapy in Ward one of Hematology Center, Beijing Children＇ s Hospital. Results There were 30 cases （47.6%） had the changes of coagulation indications before induction therapy in all 60 cases, 1. No significant relation with bleeding or thrombocytopenia （P 〉0. 05）. 2. No significant relation with leucocytosis, tumor renal infiltration and high level of GOT/UR （P 〉 0. 05 ）, but significant relation with high tissue tumor loaded and high LDH level （ P 〈 0. 05 ） ; significant relation with T -cell ALL type （6/7cases）, but no with the risk degrees of, ALL（ P 〉 0. 05 ）. 3. The complications during 2 weeks after the beginning of induction therapy ： no significance with of hyperuricemia and/or renal failure （P 〉 0. 05 ）, but very high significance of the tendency of DIC （ P 〈 0. 01 ）. Conclusion Children ALL may have changes of coagulation indications before induction therapy, 1. Clinic bleeding or thrombocytopenia can＇ t substitute of them. 2. The risk factors maybe the tissue high tumor - loaded, high level of LDH and T - cell type 3. They may indicate the occurrence of the severe complication of DIC during 2 weeks after induction therapy. So, it is important to observe of indications of coagulation changes and treat it in time. maybe the way to prevent the severe complication of DIC.