培门冬酶对成人急性淋巴细胞白血病患者凝血功能的影响及处理方法

Effect of pegaspargase on blood coagulation function in adult patients with acute lymphoblastic leukemia and its treatment

目的探讨培门冬酶对成人急性淋巴细胞白血病患者凝血功能的影响及处理方法。方法应用培门冬酶方案对33例急性淋巴细胞白血病患者进行化疗，在培门冬酶治疗前ld及治疗后4、9、14d，进行血浆凝血酶原时间（胛）、活化部分凝血活酶时间（APTT）、血浆纤维蛋白原（FIB）监测，并对纤维蛋白低于1．0g/L的患者输注适量的冷沉淀。结果33例患者经培门冬酶治疗后，31例患者出现凝血功能异常（占93．9％），以FIB下降为主：除治疗后4dPT与治疗前比较差异未见统计学意义（P〉0．05），治疗后PT、AFTT、FIB与治疗前比较差异有统计学意义（P〈0．05）。经输注适量冷沉淀治疗后，2例患者出现皮肤散在瘀斑，其余患者未见明显出血现象。治疗后2周FIB逐渐恢复，但仍未达正常，与治疗前比较差异有统计学意义（P〈0．05）。结论应用培门冬酶时需密切定期监测患者凝血功能变化，培门冬酶对FIB影响明显，必要时补充冷沉淀治疗。

Objective To discuss the effect of the pegaspargase on the coagulation function of the adult acute lymphoblastic leukemia patients and the treatment method. Methods Thirty-three patients with acute lymphoblastic leukemia were treated with an pegaspargase scheme, 1 d before the treat- ment of the pegaspargase, 4 d, 9 d and 14 d after treatment, plasma prothrombin time（PT） , activated partial thromboplastin time （AlYI＇T）, plasma fibrinogen （FIB） were monitored, and a moderate amount of cold precipitation was injected to patients with fibrin less than 1 g/L. Results After the treatment of 33 patients with pegaspargase, 31 patients had abnormal coagulation function （93.9%）, which was mainly decreased with FIB ; there was no significant difference in PT between 4 d after treatment and before treatment （P 〉 0. 05 ） , the difference of PT, APTT and FIB after treatment was statistically significant （ P 〈 0. 05 ）. The amount of infusion of cryoprecipitate after treatment, 2 patients appeared on skin eeehymosis, other patients showed no obvious bleeding. After 2 weeks of treatment, FIB was gradually recovered, but it was still not normal, and compared with before treatment, the difference was statistically significant （ P 〈 0. 05 ）. Conclusions It is necessary to monitor the changes of blood coagulation function regularly in patients with pegaspargase, and the effect of the pegaspargase on FIB is obvious, and supplemental cold precipitation treatment if necessury.