不同分子量肝素治疗急性早幼粒细胞白血病合并DIC的临床研究

Heparin of Different Molecular Weight in the Treatment of Acute Promyelocytic Leukemia Complicated with Disseminated Intravascular Coagulation

目的:探讨普通肝素和低分子肝素对急性早幼粒细胞白血病(APL)合并弥散性血管内凝血(DIC)的疗效。方法:选择我院2019年3月—2023年3月收治的52例初诊APL伴DIC患者,随机分为普通肝素(UFH)组和低分子肝素(LMWH)组,两组患者均给予双诱导缓解方案治疗,观察两组患者DIC指标改善情况、血制品输注、出血程度和1个月内完全缓解和死亡情况。结果:与治疗前相比,两组治疗后第7天血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及D-二聚体含量均明显下降,纤维蛋白原(FIB)逐渐上升(P<0.05),但低分子肝素组治疗后第3天FIB升高较普通肝素组更显著(P<0.05),两组间其余指标比较差异无统计学意义(P>0.05)。治疗第7天普通肝素组有效率为65.38%,低分子肝素组有效率为76.92%,两组间比较差异无统计学意义(P>0.05)。治疗7d内两组患者血浆、冷沉淀、血小板输注量无明显差异(P>0.05),但低分子肝素组人纤维蛋白原输注量较普通肝素组明显减少(P<0.05)。两组初始治疗7d内出血情况无明显差异。治疗第30天,普通肝素组有21例骨髓完全缓解,2例未缓解,3例因脑出血导致死亡;低分子肝素组25例骨髓完全缓解,1例因脑出血死亡;两组间比较差异无显著性(P>0.05)。结论:普通肝素和低分子肝素治疗APL合并DIC同样有效。低分子肝素可更快地提升初诊APL合并DIC患者的FIB水平,减少早期人纤维蛋白原输注,可能减少早期致命出血事件。

Objective:To study the curative effects of unfractionated heparin(UFH)and low molecular weight heparin(LMWH)in the treatment of acute promyelocytic leukemia(APL)complicated with disseminated intravascular coagulation(DIC).Methods:A total of 52 newly diagnosed patients with APL and DIC in our hospital from March 2019 to March 2023 were selected and randomly divided into UFH group and LMWH group.Both groups were treated with double-induced remission regimen.The improvement of DIC indexes,transfusion of blood products,bleeding seriousness,complete remission and death within 1 month treatment were observed in the two groups.Results:After 7 days treatment,plasma PT,APTT and D-D of the two groups were significantly decreased than those before treatment,while FIB was gradually increased(P<0.05).But the level of FIB in the LMWH group after 3 days treatment was significantly higher than that in the UFH group(P<0.05).There was no significant difference between the two groups with other indexes(P>0.05).After 7 days treatment,the effective rate was 65.38%in the UFH group and 76.92%in the LMWH group,and the difference between the two groups was not statistically significant(P>0.05).There were similar in the amount of plasma,cryoprecipitate and platelet transfusion between the two groups within 7 days treatment,but the amount of human fibrinogen transfusion in the LMWH group was significantly lower than that in the UFH group(P<0.05).There was no significant difference in bleeding within 7 days treatment between the two groups(P>0.05).After 30 days treatment,21 patients in the UFH group achieved complete remission of bone marrow,2 patients did not achieved remission,and 3 patients died of cerebral hemorrhage.In the LMWH group,25 patients achieved complete remission of bone marrow and 1 case died of cerebral hemorrhage.The difference between the two groups was no significant(P>0.05).Conclusion:UFH and LMWH are equally effective in the treatment of APL complicated with DIC.LMWH can increase the FIB level more quickly in newly diagnosed patients with APL and DIC,reduce the early human fibrinogen infusion,and may reduce early fatal bleeding events.