急性白血病TF、TFPI、t-PA以及PAI-1的变化及其意义

Investigation of coagulation and fibrinolysis system in acute leukemia

目的观察凝血和纤维蛋白溶解系统在急性白血病(AL)的变化,为 AL 凝血功能紊乱提供依据。方法采用 ELISA 法检测71例 AL 患者血浆组织因子(TF)和 TF 途径抑制物(TFPI)、组织型纤维蛋白酶原活化剂(t-PA)及其抑制物 PAI-1浓度,同时用发色底物法检测血浆蛋白 C 活性(PC:A)。30名门诊体检正常人作为对照组。结果 AL 初治组和未缓解组,TF、t-PA 和 PAI-1均增高,差异有统计学意义(TF,F=1238.5,P<0.001;t-PA,F=61.2,P<0.001;PAI-1,F=91.7,P<0.001)。TFPI 在各组之间差异无统计学意义。蛋白 C 活性在 AL 并发 DIC 组低于非 DIC 组,差异有统计学意义(F=78.1,P<0.001)。DIC 组 TF、t-PA 及 PAI-1则较非 DIC 组明显增高,差异有统计学意义(TF,F=479.0,P<0.001;t-PA,F=139.6,p<0.001;PAI,F=260.2,P<0.001)。结论 AL 患者凝血功能紊乱与凝血系统和纤维蛋白溶解系统失平衡有关,TF、t-PA 和 PAI-1与病情变化有关,可以作为 AL 的预后指标。蛋白 C 活性降低及TF、t-PA、PAI-1增高在 AL 并发 DIC 过程中有重要意义。

Objective To research the changes of coagulation and fibrinolysis systems during acute leukemia patients.Methods Measure plasma concentrations of TF,TFPI,t-PA and PAI-1 by ELISA,test protein C activity(PC:A)by chromogenic substrate assay.Results Plasma concentrations of TF,t-PA and PAI-1 become higher in the acute leukemia and the non-remission ones than normal,while decrease to nor- mal after remission.TFPI keep the same level among these teams.Protein C activity decreased when the leukemia patients combined with disseminated intervascular coagulation(DIC)while TF,t-PA and PAI-1 in- creased.Conclusion Acute leukemia is related to the disorder of coagulation and fibrinolysis system.Unbal- ance of TF and TFPI along with the disorder of t-PA and PAI-1 perhaps are the most important reasons for bleeding or thrombosis during accurate leukemia.The decrease of protein C and the increase of TF,t-PA and PAI-1 are related to the DIC combined with acute leukemia.