急性白血病止凝血异常的预后意义

Prognostic significance of hemostatic abnormalities in acute leukemia

目的 :探讨急性白血病 (AL)患者的止凝血异常及其与预后的关系。方法 :运用 EL ISA或发色底物法对 5 6例 AL 患者血浆一系列止凝血指标进行了检测。结果 :治疗前血浆血栓调节蛋白 (TM)、P-选择素、可溶性纤维蛋白单体复合物 (SFMC)、组织纤溶酶原激活物 (t- PA )、D-二聚体水平显著升高 ,蛋白 C抗原 (PC∶ Ag)、纤溶酶原激活抑制物 (PA I)水平低于正常 ,纤维蛋白原 (Fg)、蛋白 C活性 (PC∶ A )、蛋白 S水平 (PS)与正常对照组差异无显著性意义 ,治疗后除蛋白 C活性外均恢复至正常范围内 ;治疗前后 TM升高、治疗前 PS降低及 PAI升高者预后较差 ,其中治疗后 TM和治疗前 PAI是决定患者无复发生存时间的预后因素 ,治疗后 TM、治疗前 PS和 PAI水平是决定患者总生存时间的预后因素。结论 :AL发病过程中存在血管内皮细胞损伤、血小板活化以及凝血、抗凝、纤溶系统的激活 ,并随病情的好转而逐渐改善 ;血管内皮损伤。

Objective:To study the hemostatic disorders in acute leukemia (AL) and their relations with prognosis.Methods:A series of hemostatic parameters were measured among 56 cases of AL using ELISA or chromogenic substrate assay.Results:Plasma level of thrombomodulin (TM),P selectin,soluble fibrinomonomer complex (SFMC),tissue plasminogen activator and D dimer (D D) elevated significantly at diagnosis,while the antigen level of protein C (PC∶Ag) and plasminogen activator inhibitor (PAI) decreased.Fibrinogen (Fg), PC activity (PC∶A) and protein S (PS) remained unchanged. All the above variables returned to normal after complete remission (CR). Increased TM before and after treatment,decreased PS and increased PAI before treatment correlated with poor prognosis. TM after CR and PAI before treatment were independent prognostic factors considering relapse free survival of the patients. TM after CR, PS and PAI before treatment were independent prognostic factors of overall survival.Conclusion:There existed the injury of vascular endothelium, the consumption of platelets as well as the activation of coagulant, anticoagulant and fibrinolytic system in AL, which can be greatly improved after CR. The endothelium injury, as well as the consumption of PS and the activation of PAI activity correlated with the prognosis of AL patients significantly.