淋巴浆细胞淋巴瘤患者凝血指标变化及其临床意义

Changes of blood coagulation indicators in patients with lymphoplasmacytic lymphoma and their clinical significances

目的观察淋巴浆细胞淋巴瘤(LPL)患者凝血指标的变化,探讨其临床意义。方法收集2008年1月至2017年10月常州市第一人民医院20例初发LPL患者临床资料,患者均经化疗及血浆置换、补充凝血因子等支持治疗。选取20名健康体检者作为健康对照组。检测两组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D-二聚体(D—D)和血小板计数(Plt)等指标。结果与健康对照组比较,LPL组PT、APTT升高[(12.9±1.2)s比(11.6±0.9)s,(41.7±9.8)s比(24.7±2.9)s],Plt降低[112× 10^9/L(3×10^9/L^379×10^9/L)比210×10^9/L(170×10^9/L^271×10^9/L)],差异均有统计学意义(均P<0.05);而两组间FIB、TT、D—D比较,差异均无统计学意义(均P>0.05)。分泌不同免疫球蛋白类型(IgA、IgG和IgM)LPL患者的PT、APTT、TT、D-D、FIB、Plt比较,差异均无统计学意义(均P>0.05)。所有患者经治疗后凝血功能改善,无因出血、血栓死亡者。结论LPL患者存在凝血功能紊乱和血液高凝状态,且与其分泌的免疫球蛋白类型无关。临床上应重视监测凝血指标,以预防不良反应的发生。

Objective To observe the alteration and clinical significances of blood coagulation indicators in patients with lymphoplasmacytic lymphoma (LPL).Methods Twenty patients who were newly diagnosed LPL in the First People's Hospital of Changzhou from January 2008 to October 2017 and twenty healthy controls were studied.The patients were treated by chemotherapy,plasma exchange,supplement of coagulation factor or other supportive therapy.The parameters of prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB),thrombin time (TT),D-dimer (D-D),and platelet count (Plt)were detected in LPL group and healthy controls.Results The levels of PT and APTT in LPL group were dramatically higher than those in control group [(12.9±1.2)s vs.(11.6±0.9)s,(41.7±9.8)s vs.(24.7±2.9)s], and the level of Plt in LPL group was lower than that in control group [112×10^9/L (3×10^9/L -379×10^9/L)vs. 210×10^9/L (170×10^9/L -271×10^9/L)],and the differences were statistically significant (all P <0.05).There were no significant differences in FIB,TT and D-D levels between LPL group and control group (all P >0.05). There were no statistical differences in PT,APTT,FIB,TT,D-D and Plt levels among LPL patients with different types of immunoglobins (all P >0.05).After treatment,all the coagulation abnormalities got relieved and no patient died of hemorrhage or thrombosis.Conclusions The LPL patients have coagulation disorders and hypercoagulability,and this is independent of the type of immunoglobulin.Clinical attention should be paid to monitoring coagulation indicators to prevent the occurrence of adverse reactions.