儿童初诊白血病凝血指标异常及临床意义

Abnormality of blood coagulation indexes before induction chemotherapy in children with acute leukemia and its clinical significance

目的:分析儿童初诊急性白血病诱导化疗前凝血指标的改变及影响因素,探讨白血病患儿凝血功能障碍与出血的关系,指导临床治疗,减少临床出血发生率。方法:检测70例初发急性白血病(除外急性早幼粒细胞白血病)患儿的诱导化疗前凝血功能、白细胞及血小板计数、肝功能、乳酸脱氢酶、免疫分型(T细胞型及B细胞型)、白血病分型(急性淋巴细胞白血病及急性非淋巴细胞白血病)、骨髓中原始细胞比例、临床症状体征及诱导化疗前出血表现。结果:70例患儿中有59例发生凝血指标异常,其余11例凝血指标正常。凝血功能正常与异常者间T细胞型、乳酸脱氢酶含量、组织肿瘤负荷及肝功能情况均差异有统计学意义(均P<0.05)。Logistic回归分析显示骨髓中原始细胞的比例及肝功能不良是凝血指标异常的重要影响因素(均P<0.05)。通过分析凝血5项指标与临床出血的关系发现,纤维蛋白原与临床出血的发生关系更密切(P<0.05)。结论:儿童白血病诱导化疗前凝血指标异常发生率高,影响凝血指标的因素可能包括乳酸脱氢酶高、组织肿瘤负荷大、T细胞型白血病及肝功能不良。起病时骨髓中原始细胞比例高及肝功能不良可引起凝血指标改变。血浆纤维蛋白原减低与临床出血表现关系更密切。

Objective：To analyze abnormality of blood coagulation indexes and the influencing factors before induction chemotherapy in children with acute leukemia,and to explore the correlation between clinic bleeding and abnormal blood coagulation,which guide treatment and reduce the complication after chemotherapy.Method：We detected the coagulation indexes in the newly diagnosed childhood with acute leukemia（except for APL）and analyzed the correlation between blood coagulation indexes and WBC,PLT,liver function,LDH,immunophenotyping, type of acute leukemia,proportion of blast cells in bone marrow,clinical signs and bleeding symptoms by singleand multi-variable analysis.Result：A total of 59cases had coagulation disorders before induction therapy among the 70cases.Changes of blood coagulation,LDH,immunophenotyping,abnormal liver function and high tumor burden had significant differences between the patients with normal and abnormal coagulation function（P〈0.05）.Multiple Logistic regression analysis showed incidence of abnormal coagulation indexes was significantly related to proportion of blast cells in bone marrow and abnormal liver function（P〈0.05）.Decreased plasma fibrinogen level was correlated with abnormal blood coagulation（P〈0.05）.Conclusion：The risk factors may include high LDH, immunophenotyping,abnormal liver function and high tumor burden.Decreased plasma fibrinogen level is correlated with bleeding symptoms.Detection of coagulation indexes may help to estimate whether the childhood patients are in a state of hypercoagulability.