止凝血分子标志物在急性白血病合并DIC中的意义

The significance of molecular markers of blood coagulation and hemostasis in acute leukemia complicated with disseminated intravascular coagulation

目的探索血浆止凝血分子标志物检测在急性白血病(AL)合并弥散性血管内凝血(DIC)诊断和预后判断中的价值。方法采用ELISA方法检测77例AL(37例合并DIC,40例AL未合并DIC)患者血浆血小板α颗粒膜糖蛋白-140(GMP-140)、抗凝血酶-Ⅲ(AT-Ⅲ)、D-二聚体(D-D)、凝血酶-抗凝血酶复合物(TAT)、凝血酶原片段F1+2、纤溶酶-抗纤溶酶复合物(PAP)含量,并与38例正常人对照。结果AL合并DIC早期F1+2、D-D、TAT含量均显著高于正常对照组(P<0.01),GMP-140、PAP含量明显高于正常对照组(P<0.05),AT-Ⅲ活性显著降低,与正常对照组比较差异有显著性意义(P<0.05);在DIC中晚期F1+2、D-D、TAT、GMP-140明显升高,AT-Ⅲ活性明显降低(P<0.01),经直线相关分析,D-D与F1+2、GMP-140、TAT在DIC患者中有显著性相关(r=0.871,P<0.01;r=0.697,P<0.05;r=0.763,P<0.05)。AL未合并DIC者GMP-140、D-D、PAP水平明显升高,AT-Ⅲ活性明显降低(P<0.05),AL合并DIC患者各期GMP-140、TAT、F1+2、D-D、PAP水平明显升高,与AL未合并DIC比较有显著性差异(P<0.05)。结论止凝血分子标志物是能早期反映体内凝血、抗凝及纤溶系统激活的敏感性指标,在DIC早期诊断中有着重要实用价值。止凝血分子标志物检测有助于急性白血病病情观察,可作为疗效观察的辅助指标。

Objective To investigate the value of molecular markers of blood coagulation and hemostasis measurement in diagnosis and prognosis estimate of acute leukemia complicated with disseminated intravascular coagulation（DIC）. Methods A series of blood coagulation and hemostatic molecular markers,including GMP-140,AT-Ⅲ, TAT,D-D,F1 ＋2 PAP were measured in 77 patients with acute leukemia （37 cases with DIC and 40 cases without DIC ） and 38 cases normal controls. Results The plasma levels of F1.2-D-D and TAT were significantly higher in early stage of DIC than in normal controls group （ P 〈 0.01 ） ,levels of GMP-140 and PAP were significantly higher in early stage of DIC than in normal controls group （P 〈0.05） ,and the activities of AT-Ⅲ was significantly lower than those in control group（P 〈 0.05 ）. The plasma levels of F1 ＋2 ,D-D, TAT and GMP-140 were significantly higher in mid and late stage of DIC than in normal controls group （ P 〈 0.01 ）, and the activities of AT- Ⅲ was significantly lower than those in control group（P 〈0.01 ）. the D-D levels showed positive correlation with F1 ＋2 ,GMP-140 ,TAT（ r = 0.871, P 〈 0.01 ; r = 0.697, P 〈 0.05 ; r = 0.763, P 〈 0.05 ）. The plasma levels of GMP-140, D-D, PAP were significantly higher and the activities of AT-Ⅲ was significantly lower than those in control group （P 〈0.05）. The plasma levels of GMP-140,TAT,F1 ＋2 ,D-D,PAP in patients acute leukemia with DIC were significantly higher than those in patients acute leukemia without DIC（ P 〈 0.05 ）. Conclusion The molecular markers of blood coagulation and hemostasis are sensitive indexes, which can early reflect coagulation,anti- coagulation and fibrinolysis. They had important practical value in the early diagnosis of DIC. monitoring the levels molecular markers of blood coagulation and hemostasis may have prognostic value in clinical outcome and is useful marker treatment of AL patients.