中药血必净注射液对粒细胞缺乏伴发热急性髓系白血病患者止凝血功能的影响

Hemostatic effect of Xuebijing injection in the febrile agranulocytosis patients with acute myeloid leukemia

目的探究中药血必净注射液对化疗后粒细胞缺乏伴发热的急性髓系白血病患者止凝血功能和出血风险的影响。方法回顾性分析62例粒细胞缺乏伴发热急性髓系白血病患者的临床资料,根据患者治疗方案分为对照组和观察组,每组31例。对照组患者接受常规治疗,观察组患者在常规治疗基础上加用中药血必净注射液。分析和比较两组患者治疗前后血小板计数(PLT)、凝血酶原时间(PT)、部分凝血酶原时间(APTT)、纤维蛋白原含量(Fg)、血浆D-二聚体(D-D)水平和纤溶酶原激活抑制物-1(PAI-1)活性等止凝血功能指标。同时应用中国2016版原发免疫性血小板减少症(ITP)出血评分量表,对两组患者进行出血评分并进行比较。结果治疗后7 d,观察组患者PT、APTT、血浆D-D水平以及PAI-1活性分别为(10.55±1.43)s、(28.95±4.44)s、(1.19±0.86)mg/L及(59.47±9.19)%,明显低于对照组[(12.33±1.49)s、(33.79±5.05)s、(1.92±0.71)mg/L和(65.73±7.14)%,P <0.05或P <0.01],而Fg含量[(3.29±1.01)g/L]显著高于对照组患者[(2.27±0.66)g/L,P <0.01],但两组PLT无显著差异(P> 0.05)。治疗后对照组和观察组出血评分为0、1、2、3及5分,患者分别为10例和9例(32.3%对29.0%)、15例和16例(48.4%对51.6%)、5例和4例(16.1%对12.9%)、1例和2例(3.2%对6.5%)及0例和0例(0%对0%),差异无统计学意义(P> 0.05)。结论血必净能够通过调变凝血功能和纤溶活性而改善粒细胞缺乏伴发热急性髓系白血病患者止凝血指标,但并未显著减少出血事件,故采用含有血必净的治疗方案能否降低凝血相关并发症的发生几率有待进一步研究。

Objective To explore the hemostatic function and bleeding risk of Xuebijing injection on the febrile agranulocytosis patients with acute myeloid leukemia.Methods A total of 62 febrile agranulocytosis patients with acute myeloid leukemia were retrospectively identified and systemically analyzed.These patients were further divided into two groups according to their therapeutic schedules.The control group was given conventional treatment alone,and the observation group received Xuebijing injection integrated into basic therapeutic approaches.The markers of hemostatic function were compared and systemically analyzed between two groups,which included prothrombin time(PT),activated partial thromboplastin time(APTT),serum levels of platelet(PLT),fibrinogen(Fg) and its degradation products D-dimer(D-D) as well as the activities of plasminogen activator inhibitor-1(PAI-1).The bleeding scores were also assessed and compared between two groups by Chinese ITP bleeding scale(version 2016).Results After seven days treatment,the clotting time including PT and APTT as well as D-D levels and PAI-1 activities in observation group patients [(10.55±1.43)s、(28.95±4.44)s、(1.19±0.86)mg/L and(59.47%±9.19%)%] were significantly lower than those in control group[(12.33±1.49)s、(33.79±5.05)s、(1.92±0.71)mg/L and(65.73±7.14)%,P<0.05 or P<0.01].Meanwhile,Fg level in observation group patients [(3.29±1.01)g/L] was considerably higher than those in control group [(2.27±0.66)g/L,P<0.01].However,there was little difference in serum PLT levels between two groups(P>0.05).The bleeding episodes classified as grade 0,1,2,3 and 5 in Chinese ITP bleeding scale were respectively occurred in 10 vs 9(32.3%vs 29.0%),15 vs 16(48.4% vs 51.6%),5 vs 4(16.1% vs 12.9%),1 vs 2(3.2% vs 6.5%) and 0 vs 0(0% vs 0%),which showed no significant difference between two groups(P>0.05).Conclusions Xuebijing injection could improve hemostatic function in febrile patients with acute myeloid leukemia through modulation of coagulation cascade as well as activities of fibrinolysis.