组织因子及组织因子微粒在急性髓系白血病中的检测及临床意义

Detection and clinical significance of tissue factor and microparticle-associated tissue factor in acute myeloid leukemia

目的:通过检测急性髓系白血病(AML)患者血浆中组因子(TF)及组织因子微粒(MP-TF)的表达,探讨其在AML凝血异常中的临床意义。方法:选择AML住院患者64例(AML组),其中急性早幼粒细胞白血病(APL)22例,非APL 42例;并发弥散性血管内凝血(DIC)22例,未并发DIC 42例。非APL中13例治疗后骨髓完全缓解(CR),APL中15例治疗后骨髓达CR,包含12例APL并发DIC患者。对照组34例均为健康献血员。采用流式细胞术检测MP-TF,ELISA法检测血浆中TF。结果:治疗前AML组MP-TF及TF水平明显高于对照组[(60.90±14.90)%∶(45.80±12.03)%,P<0.01;(129.11±37.32)pg/ml∶(95.96±19.56)pg/ml,P<0.05]。AML组内,15例治疗后骨髓达CR的APL患者治疗前后MP-TF水平差异有统计学意义[(60.13±8.95)%∶(51.65±8.11)%,P<0.05],其中12例APL并发DIC患者治疗前MP-TF及TF水平均高于治疗后[(60.00±9.45)%∶(56.70±17.10)%;(155.67±31.14)pg/ml∶(122.03±18.41)pg/ml,均P<0.05];13例治疗后骨髓达CR的非APL患者治疗前TF明显高于治疗后[(147.61±27.43)pg/ml∶(118.73±20.23)pg/ml,P<0.01]。AML组内,凝血酶原时间(PT)延长>3s的患者(10例)MP-TF水平明显高于PT延长<3s及PT正常的患者(54例)[(64.10±9.38)%∶(59.40±19.73)%,P<0.05];纤维蛋白降解产物(FDP)异常的患者(24例)TF水平明显高于FDP正常患者(40例)[(152.26±37.89)pg/ml∶(112.81±35.47)pg/ml,P<0.05]。结论:MP-TF及TF是参与凝血异常的重要指标,MP-TF较血浆TF能更好地反映TF活性水平,且MP-TF与AML尤其是APL及其凝血异常有密切关系,可作为监测APL疾病病情缓解的有效指标之一。

Objective：To detect and explore the clinical significance of tissue factor（TF） and microparticle-associated tissue factor（MP-TF） in acute myeloid leukemia（AML） patients. Method：The peripheral blood in 64 cases of AML with newly diagnosed was collected,including 22 cases of APL,42 cases of non-APL,and 22 cases of AML with DIC and 42 cases of AML without DIC.Thirteen cases of non-APL with bone marrow complete remission（CR）,15 cases of APL with bone marrow CR including 12 cases of APL with DIC.Thirty-four cases of normal controls were healthy blood donors.MP-TF was detected by FCM and TF was detected by ELISA. Result：MP-TF and TF in AML patients were both higher than those in the normal controls（P0.01,P0.05）.MP-TF in the 15 cases of APL with bone marrow CR was higher before chemotherapy than that after chemotherapy（P0.05）.The levels of MP-TF and TF in 12 cases of APL with DIC were higher before chemotherapy than those after chemotherapy（P0.05）.TF in the 13 cases of non-APL with bone marrow CR was higher before chemotherapy than that after chemotherapy（P0.01）.The MP-TF in the patients with PT3 s was higher than that with normal PT value（P0.05）.TF in the patients with abnormal FDP value was increased than that with normal FDP（P0.05）. Conclusion：MP-TF and TF are important indicators involved in coagulopathy,and MP-TF could better reflect the activity of TF.MP-TF is associated with haemostatic dysfunction in the AML,and it could be used as a factor to monitor disease remission.