急性白血病患者凝血指标和VEGF的检测及临床意义

Detection and Clinical Significance of Coagulation Index and VEGF in Patients with Acute Leukemia

目的探讨凝血指标和血管内皮生长因子(VEGF)在急性白血病(AL)诊治中的临床意义。方法选择2018年8月至2020年12月河北北方学院附属第一医院收治的102例AL患者为研究对象,其中急性髓系细胞白血病(AML)患者80例[包括急性早幼粒细胞白血病(APL)患者18例、M13例、M231例、M417例、M511例]、急性淋巴细胞白血病(ALL)患者22例,选择同期100名健康体检者作为对照组。检测对照组与AL患者初诊时及治疗完全缓解后的纤维蛋白原(FIB)、D-二聚体、纤维蛋白原降解产物(FDP)、抗凝血酶原Ⅲ(AT-Ⅲ)、纤维蛋白单体(FM)及VEGF水平。结果AL组初诊患者FIB、AT-Ⅲ水平明显低于对照组(P<0.01),D-二聚体、FDP、FM、VEGF水平明显高于对照组(P<0.01)。APL组(除APL)初诊患者FIB、AT-Ⅲ水平低于AML组[(1.6±0.9)g/L比(2.5±0.3)g/L、(43.1±4.4)%比(54.7±4.5)%](P<0.01),D-二聚体、FDP、FM、VEGF水平高于AML组[(11.9±3.7)mg/L比(7.2±2.5)mg/L、(38.2±6.0)mg/L比(21.0±4.6)mg/L、(38.5±2.8)mg/L比(24.7±4.2)mg/L、(176±20)ng/L比(131±18)ng/L](P<0.01)。治疗后达完全缓解时,AML组与ALL组FIB、AT-Ⅲ水平高于治疗前,D-二聚体、FDP、FM、VEGF水平低于治疗前(P<0.05),但两组间各指标比较差异无统计学意义(P>0.05)。AL患者初诊时D-二聚体、FDP、FM、VEGF水平与骨髓原幼细胞数呈正相关(r=0.391,P=0.010;r=0.348,P=0.016;r=0.732,P=0.013;r=0.529,P=0.001),FIB、AT-Ⅲ水平与骨髓原幼细胞数呈负相关(r=-0.371,P=0.017;r=-0.501,P=0.007)。结论检测AL患者的FIB、D-二聚体、FDP、AT-Ⅲ、FM及VEGF水平,有利于及时评估患者的出血风险,监测治疗效果,对疾病的诊疗具有重要意义。

Objective To investigate the significance of coagulation indexes and vascular endothelial growth factor(VEGF)in the diagnosis and treatment of acute leukemia(AL).Methods A total of 102 patients with AL admitted to the First Affiliated Hospital of Hebei North University from Aug.2018 to Dec.2020 were included.There were 80 patients with acute myeloid leukemia(AML)[including 18 patients with acute promyelocytic leukemia(APL),3 patients with M1,31 patients with M2,17 patients with M4 and 11 patients with M5]and 22 patients with acute lymphoblastic leukemia(ALL),and 100 healthy people during the same period were included as a control group.The levels of fibrinogen(FIB),D-dimer,fibrinogen degradation product(FDP),antithrombin-Ⅲ(AT-Ⅲ),fibrin monomer(FM)and VEGF in the AL group and control group at initial diagnosis and after complete remission were detected.Results The levels of FIB and AT-Ⅲin the AL group at initial diagnosis were significantly lower than those in the control group(P<0.01),while the levels of D-dimer,FDP,FM and VEGF were significantly higher than those in the control group(P<0.01).The level of FIB and AT-Ⅲin the APL group was lower than that in the AML group[(1.6±0.9)g/L vs(2.5±0.3)g/L,(43.1±4.4)%vs(54.7±4.5)%](P<0.01),the levels of D-dimer,FDP,FM and VEGF were higher than those of the AML group[(11.9±3.7)mg/L vs(7.2±2.5)mg/L,(38.2±6.0)mg/L vs(21.0±4.6)mg/L,(38.5±2.8)mg/L vs(24.7±4.2)mg/L,(176±20)ng/L vs(131±18)ng/L](P<0.01).When complete remission was achieved after treatment,the levels of FIB and AT-Ⅲin the AML group and ALL group were higher than before treatment,while the levels of D-dimer,FDP,FM and VEGF were lower than before treatment(P<0.05),but there was no statistically significant difference in each index between the two groups(P>0.05).The levels of D-dimer,FDP,FM and VEGF were positively correlated with the number of bone marrow protoblasts in the AL patients at initial diagnosis(r=0.391,P=0.010;r=0.348,P=0.016;r=0.732,P=0.013;r=0.529,P=0.001),and the level of FIB and AT-Ⅲwas negatively correlated with the number of bone marrow protoblasts(r=-0.371,P=0.017;r=-0.501,P=0.007).Conclusion Detection of FIB,D-dimer,FDP,AT-Ⅲ,FM and VEGF levels in patients with AL is conducive to the assessment of the risk of bleeding,and monitoring the treatment effect,which is of great significance for the diagnosis and treatment.