急性早幼粒细胞白血病凝血紊乱机制及诱导治疗期间凝血纤溶参数的变化

Study on the mechanism of acute promyelocytic leukemia coagulopathy and the recovery of coagulation and fibrinolysis parameters in induction regimens

急性早幼粒细胞白血病(acute promyelocytic leukemia,APL)患者极易发生出血及血栓并发症,其凝血紊乱的临床表现和实验室检查特征与传统的脓毒性弥散性血管内凝血明显不同。研究认为APL凝血紊乱的主要发生机制包括外源凝血通路激活和原发纤溶亢进,直接依据包括组织因子、癌性促凝物及膜联蛋白Ⅱ表达增加。常见的诱导缓解药物有全反式维甲酸、亚砷酸及蒽环类药物为主的化疗,且各疗法诱导治疗过程中凝血纤溶参数的变化各有差异。现就APL凝血紊乱发生机制的研究进展及诱导治疗期间凝血纤溶参数的变化作一综述。

Acute promyelocytic leukemia patients are prone to appear bleeding and thrombotic complications.Coagulopathy occurs in most patients with APL and is life-threatening.There are many differences between the coagulopathy of APL and sepsis-associated DIC on the clinical manifestations and laboratory findings.Recent research have suggested that the hemorrhagic diathesis was associated with exogenous coagulation and primary hyperfibrinolysis.The high level of tissue factor,cancer procoagulant and Annexin Ⅱ are the main determinants of these processes.APL induction therapy include all-trans retinoic acid and arsenic trioxide and anthracycline-based chemotherapy.This review is about the mechanism of APL-related coagulopathy and the recovery of coagulation and fibrinolysis parameters in induction regimens.