儿童急性淋巴细胞白血病凝血功能变化与左旋门冬酰胺酶的关系

A Clinical Study of L-asparaginase on Coagulation Alterations in Children with Acute Lymphoblastic Leukemia

目的:了解左旋门冬酰胺酶(L-ASP)对儿童急性淋巴细胞白血病凝血功能变化的影响。方法:观察86例患儿在诱导缓解后治疗期间,L-ASP使用前后活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、抗凝血酶Ⅲ(AT-Ⅲ)、D-二聚体变化情况。结果:与用药前比,用药结束后一天的PT、APTT、TT均显著延长(P<0.01);FIB、AT-Ⅲ显著降低(P<0.01),D-二聚体显著升高(P<0.01);用药结束后1周时PT、APTT、TT、D-二聚体较用药前差异无显著性,FIB、AT-Ⅲ虽有回升,但仍低于正常(P<0.01)。结论:L-ASP可引起ALL患儿凝血功能异常,尤其对FIB、AT-Ⅲ影响明显,应引起临床高度重视。L-Asp主要影响蛋白质的合成而引起蛋白质成份的凝血因子减少,从而引起凝血功能障碍,且对纤维蛋白原的合成影响更为显著。

Objective： To analyze the alterations of coagulation in children with acute lymphohlastic leukemia （ALL） during L -asparaginase （L- Asp） treatment. Methods： Eighty - six cases of post - remission ALL, were analyzed prospectively with changes of activated partial thromboplastin time （APTT）, protkrombin time （PT）, thrombin time （TT）, blood plasma fibrinogen （ FIB ） , antithrombin Ⅲ （ AT - Ⅲ） and D - dimer （ D - D ） before and after L - asparaginase treatment. Results ： On the first dayafter treatment, PT, APTT and TT were statistically prolonged （P 〈 0.01 ）, meanwhile FIB and AT- Ⅲ showed a significant decrease （P 〈 0.01 ）, D- D raised compared with before treatment. However, one week after treatment, there were no significant changes of P-F, APTT, Tr and D - D; FIB and AT- Ⅲ raised, whereas remained below the normal range （ P 〈 0.01）. Conclusion： The use of L- asparaginase may lead to coagulation abnormality in children with ALL, especially the ＇,abnormality of FIB and AT-Ⅲ. It is necessary to pay great attention to the phenomenon.