左旋门冬酰胺酶治疗急性淋巴性白血病时凝血功能的观察

Observation of Changes of Coagulation Indexes with L-asparaginase Intervention in Acute Lymphoid Leukemia

目的观察左旋门冬酰胺酶(L-ASP)治疗急性淋巴性白血病(ALL)时对患者凝血功能的影响。方法2012年6月到2015年5月共收集64例ALL患者作为研究对象,随机分为对照组、观察组各32例,两组均给予常规化疗,观察组加用,监测治疗前、后患者凝血酶原时间(PT)、部分凝血活酶时间(a PTT)、凝血酶时间(TT)、纤维蛋白酶(Fbg)、D二聚体(D-D)、外周血小板计数(PLT)等指标的变化,统计两组治疗不良反应发生率。结果治疗前,两组PT、a PTT、TT对比差异无统计学意义(P>0.05);L-ASP治疗4 d,观察组PT、a PTT、TT均延长,而对照组无明显变化(P<0.05),治疗结束3 d,观察组PT、a PTT、TT均缩短,与对照组相比差异无统计学意义(P>0.05);治疗前,两组Fbg、DD、PLT对比时下差异无统计学意义(P>0.05);左旋门冬酰胺酶治疗4 d,观察组Fbg降低,D-D、PLT上升,与对照组相比差异有统计学意义(P<0.05),治疗结束3 d,观察组Fbg上升,D-D、PLT有所降低,其Fbg、D-D与对照组相比差异仍有统计学意义(P<0.05);结论采用L-ASP治疗ALL可导致患者凝血机制异常,但停药后可恢复。

Objective To analyze effects of L-asparaginase( L-ASP) on coagulation indexes of patients with acute lymphoid leukemia( ALL). Methods 64 patients with ALL from June 2012 to May 2015 were enrolled in the study,they were divided by random number table into the control group and the observation group( each 32 cases),the two groups were given conventional chemotherapy,the observation group added lasparaginase intervention,before the treatment,after the treatment,patients' prothrombin time( PT),activated partial thromboplastin time( a PTT),thrombin time( TT),fibrin ferment( Fbg),D-dimer( D-D),peripheral blood platelet count( PLT) and other indexes were monitored,incidence of adverse drug reactions in the two groups were recorded. Results Before the treatment,there was no significant difference in PT,a PTT and TT in the two groups( P > 0. 05); 4 d of lasparaginase treatment,PT,a PTT and TT in the observation group were significantly prolonged( P < 0. 05),3 d after the treatment,PT,a PTT and TT of the observation group were slightly shortened compared with the control group( P > 0. 05); before the treatment,there was no significant difference in Fbg,D-D and PLT in the two groups( P > 0. 05); 4 d of lasparaginase treatment,Fbg of the observation group was significantly reduced,D-D and PLT were significantly increased compared with the control group( P < 0. 05),3 d after the treatment,Fbg of the observation group was increased,D-D and PLT were decreased,there was a significant difference in Fbg and D-D compared with the control group( P <0. 05). Conclusion Application of L-ASP in treating ALL can lead to coagulation function anomaly,but it can return normal after withdrawal the medications,has its reversibility.