恶性淋巴瘤患者凝血纤溶指标变化的意义

Clinical significance of the changes of coagulation and fibrolysis parameters in malignant lymphomas

目的探讨恶性淋巴瘤患者凝血纤溶指标的变化，提高对恶性淋巴瘤患者合并血栓的认识。方法应用全自动血凝分析仪对20名健康对照及71例恶性淋巴瘤患者的血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原定量（FIB）及凝血酶时间（TT）进行检测，用免疫散射比浊法测定两组血浆D-二聚体（D—DI）的含量。结果71例恶性淋巴瘤患者APTT（30．44±1．43）s、FIB（3．28±0．20）g／L、D—DI（297．05±56．59）μg／L均高于健康对照组的（23．72±0.76）s、（2．57±0．22）μg／L、（94．50±26．07）μg／L，差异有统计学意义（19〈0．05）。Ⅰ、Ⅱ期淋巴瘤患者各项凝血纤溶指标较健康对照组差异无统计学意义（P〉0．05）。llI、IV期淋巴瘤患者APTF延长，FIB增高，与健康对照组及Ⅰ、Ⅱ期组比较差异有统计学意义（P〈0．05）。合并静脉血栓患者7例，该组与Ⅰ、Ⅱ期患者相比FIB及D—DI均高，与Ⅲ、Ⅳ期患者相比D-DI明显升高。结论恶性淋巴瘤患者存在凝血纤溶指标的异常，需定期动态检测，化疗后易发生静脉血栓，需及早预防，延长患者生存期。

Objective To explore the clinical significance of the coagulation and fibrolysis parameters changes for the knowledge of complicated thrombosis after chemotherapy in malignant lymphomas. Methods Morning fasting anti-coagulation blood samples were taken to detect plasma prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （FIB） and thrombin time （Tl＇） with automatic coagulation analyzer in 71 hospitalized malignant lymphomas and 20 normal controls. The plasma D-dimer levels of the two groups were detected with immunoturbidimetry. Results The levels of plasma APTT, Fib and D-dimer in 71 malignant lymphomas were （30.44±1.43） s, （3.28±0.20） g/L, （297.05±56.59）μg/L respectively, which were significantly higher than those in normal controls at the levels of （23.72±0.76） s, （2.57±0.22） g/L, （94.50± 26.07）μg/L respectively （P 〈0.05）. The coagulation and fibrolysis parameters were of no statistic differences between the normal controls and lymphomas of stage Ⅰ and Ⅱ （P 〉0.05）. The APTT and Fib levels in lymphomas of stage Ⅲ and IV were higher than those in normal controls and lymphomas of stage Ⅰ and Ⅱ （P 〈0.05）. There are 7 malignant lymphomas complicated venous thrombosis . Of the 7 cases, the FIB and Ddimer levels were higher than those of stage Ⅰ and Ⅱ, furthermore the D-dimer levels were higher than those of stage m and IV. Conclusion The abnormalities of coagulation and fibrolysis parameters occurred in malignant lymphomas with requirement of periodic monitoring. After chemotherapy, the lymphoma patients had a high incidence of venous thrombosis, which need early prevention for prolongation of the survival.