急性早幼粒细胞白血病血浆GMP-140与vWF的表达

A Study on GMP-140 and vWF Levels in Patients with Acute Promyelocytic Leukemia

目的了解急性早幼粒细胞白血病(APL)患者血浆中血小板颗粒膜蛋白140(GMP-140)及血管性血友病因子(vWF)水平的变化规律,以期为临床诊治APL合并的凝血病提供理论依据。方法(1)应用双抗体夹心ELISA法检测APL患者初诊、治疗中(第14天左右)、缓解时及正常人的血浆GMP-140水平,并计算GMP-140(ng)/107血小板数;(2)应用增强免疫胶乳法测定上述各期患者的血浆vWF:Ag水平。结果(1)APL患者在初诊与治疗中GMP-140(ng)/107血小板数(4.55±3.10,4.73±2.78)显著高于正常对照(0.94±0.67)(P<0.01),缓解期(1.08±0.65)则与正常对照无显著差异(P>0.05)。(2)APL患者各病期vWF水平(%)(初诊时245.00±82.83,治疗中257.22±104.18,缓解期193.62±61.15)均较正常对照组(129.34±34.57)升高(初诊和治疗中P<0.01,缓解期P<0.05);缓解时的vWF水平较初诊时、治疗中明显下降(P<0.05)。结论APL患者发病过程中可能存在着血小板活化及内皮损伤,随着化疗的进行,骨髓造血逐渐改善,血小板的功能趋于正常;而内皮损伤恢复更慢,因而化疗中及化疗后期也应注意血栓的形成。

Objective To investigate the changes of granular membrane protein 140kD （ GMP- 140） and von Willenbrand factor（vWF） levels in patients with acute promyelocytic leukemia（APL）. We hope to provide some useful information for the early diagnosis of APL-complicated hemorrhage for patients with APL during clinical treatment. Methods （ 1 ） The concentration of GMP- 140 in plasma of APL patients were determined using commercially available enzyme- linked immunosorbent assay （ ELISA）, and GMP- 140 （ng）/10^7 platelets was calculated. （2） The level of vWF：Ag in plasma of all the eases were determined using the enhanced immuno-latex assay. Results （1）The GMP-140（ ng）/10^7 platelets in the cases of incipient and treatment stage increased overtly than that of control group （ P 〈 0.01 ）, while patients got relieved there was no statistical difference （ P 〉 0.05 ） between patients and control group. （ 2 ） The vWF levels of all stages increased overtly than that of control group （ incipient and treatment stage ,P 〈 0.01 ; relieved stage ,P 〈 0.05 ）. Compared with incipient and treatment stage, the vWF levels of relieved stage was decreased significantly （P 〈 0.05 ）. Conclusions The activating of platelets and the damaging of endothelium exist during the APL process. Along with the chemotherapy, bone marrow hematopoiesis become recovery, the platelets change to be normal , but the recovery of endothelium were more slowly.