急性白血病患者化疗后骨髓抑制期血浆凝血因子ⅫⅠ水平及其对出血事件的影响

Reduction of FⅫⅠ during myelosuppression in acute leukemia after chemotherapy and adverse relation with bleeding events

目的探讨急性白血病患者化疗后骨髓抑制期外周血凝血因子ⅫⅠ(FⅫⅠ)浓度与出血事件的关系。方法纳入2017年8月至2018年3月期间55例PLT<50×10^9/L的化疗后骨髓抑制期急性白血病患者(非急性早幼粒细胞性急性髓系白血病35例,急性淋巴细胞白血病20例),以35例非血液疾病患者作为对照组。用ELISA方法检测外周血FⅫⅠ浓度,分析急性白血病患者化疗后骨髓抑制期外周血FⅫⅠ水平与出血事件的关系。结果急性白血病患者化疗后骨髓抑制期FⅫⅠ水平明显低于对照组(P<0.001),FⅫⅠ水平与出血评分呈负相关(Spearman相关系数为-0.761)。当FXIII浓度的临界值为103.9μg/L时,诊断化疗后骨髓抑制期急性白血病患者出血的敏感性为0.939,特异性为0.909。结论化疗后骨髓抑制期急性白血病患者外周血FXIII水平减低,且与出血事件及严重程度呈负相关,是急性白血病化疗后骨髓抑制期患者出血的独立影响因素之一。

Objective To explore the relationship between plasma coagulation factor ⅫⅠ(FⅫⅠ)and bleeding events.Methods A total of 55 cases of acute leukemia(AL)at the myelosuppression phase after chemotherapy hospitalized in our hospital from August 2017 to March 2018 were enrolled,with 35 normal controls.The concentration of plasma coagulation factor ⅫⅠ(FⅫⅠ)was detected by ELISA to determine the relationship between the plasma FⅫⅠ levels in AL patients at the myelosuppression phase after chemotherapy with bleeding events.Results The level of FⅫⅠ in AL patients at the myelosuppression phase after chemotherapy was significantly lower than that in controls(P<0.001).The level of FⅫⅠwas inversely related with the bleeding severity(the Spearman correlation coefficient-0.761).Given the diagnosis cut-off point of FⅫⅠ concentration as 103.9μg/L,the sensitivity of diagnosing bleeding in AL patients at the myelosuppression phase after chemotherapy was 0.939,and the specificity 0.909.Conclusion AL patients at the myelosuppression phase after chemotherapy had low level of plasma FⅫⅠ,and patients with lower plasma FⅫⅠ associated with higher incidence and severity of bleeding.FⅫⅠ level was an independent influencing factor of bleeding in AL patients at the myelosuppression phase after chemotherapy.