低分子量肝素对儿童急性白血病DIC早期干预研究

Effect of early intervention using low molecular weight heparin in DIC in children with acute leukemia

目的观察低分子量肝素(LMWH)在初治急性白血病(AL)患儿化疗早期干预治疗疗效。方法将初次接受化疗的60例AL患儿随机分成两组,干预组30例:在诱导缓解治疗的同时加用LMWH;对照组30例;在弥散性血管内凝血(DIC)发生前不应用LMWH,其他治疗同干预组。观察各组治疗前后凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原定量(FIB)、抗凝血酶Ⅲ(AT-Ⅲ)、D-二聚体(D-D)、血小板(PLT)和临床出血倾向等变化。结果干预组在应用LMWH治疗后3d,AT-Ⅲ较治疗前明显升高(t=4.6360,P<0.05),D-D下降显著(t=9.3091,P<0.05),出血倾向于治疗后5d明显改善,无一例发生DIC;对照组与干预组同期相比APTT明显延长(t=4.2574,P<0.01),D-D水平升高明显(t=11.0665,P<0.01),出血倾向明显且恢复慢。结论LMWH在初治AL化疗导致血凝障碍的早期干预疗效明显,出血倾向明显减轻;LMWH具有半衰期长,抗Xa因子作用强,使用方便等优点,值得推广和使用。

Objectives To observe the effect of low molecular weight heparin （LMWH） on abnormal coagula- tion in children with acute leukemia （AL） during early stage of chemotherapy. Methods Sixty patients with AL were randomized into control group （without LMWH before disseminated intravascular coagulation （DIC） happened, n = 30） and treated group （with LMWH accompanied with inductive treatment, LMWH 125 U/kg, q12 h, IH, n = 30）. Prothrombin time, activated partial thromhin time, fibrinogen, antithrombin-III, D-dimer and platelets were analyzed before and during treatment with LMWH in treated group and control group. Bleeding tendency and the incidence of DIC were also he observed. Results The level of antithrombin-m was greatly improved （t = 4.6360, P 〈 0.05）, and D-dimer was significantly decreased （t = 9.3091, P 〈 0.05） in treated group 3 days after using LMWH, the hleeding tendency also greatly improved 5 days after using LMWH, with none had DIC; meanwhile, the control group had ob- viously prolonged activated partial thrombin time （t = 4.2574, P 〈 0.01 ） and higher D-dimer level （t = 11.0665, P 〈 0.01 ）, the bleeding tendency also required longer time to recover, compared with the LMWH treated group. Conclu- sions The effects of LMWH on AL with abnormal coagulation system is evident; bleeding tendency and the incidence of DIC were greatly decreased. Advantages of relatively long half-life, strong effect against Xa factor and convenient for use make LMWH a useful interventional tool for extensive application.