333例初诊急性白血病的CDSS实验指标分析
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摘要
目的:分析初诊急性白血病(AL)患者的CDSS 5项实验指标,为临床及早诊治AL继发的DIC提供实验室依据。方法:将333例AL患者分为AML-M1等(AML-M1-M5,其它AML和ALL)7个组,并以100例健康体检者作为对照组。观察各组的实验指标变化、CDSS评分值并进行两两比较,同时分析所有病例中的早期死亡等临床事件。结果:5项实验指标中阳性率最高的是血小板(59.76%),其次是D-D(30.93%),而APTT最低(2.70%);与对照组比较,除APTT(3组)和FIB(其他AML组)外,其余实验指标结果的差异均有非常显著的统计学意义(PAML-M<0.01);所有AL的CDSS之实验室指标评分值为1.50±1.51分,而达到现症DIC诊断标准者(≥4分)47例,阳性率为14.11%;CDSS评分值最高为AML-M3组,为3.34±1.71分。AL DIC患者早期死亡和脑(肺)出血事件发生率均明显高于AL非DIC患者(P<0.05,P<0.01)。结论:CDSS量化式积分法标准客观易行,对急性白血病继发DIC的早诊断、早治疗具有重要的临床意义。
Objective: To analyze the 5 experimental indexes of CDSS in the patients with acute leukemia(AL) so as to provide the laboratorial basis for the early diagnosis and treatment of the secondary DIC in AL. Methods: Three hundred and thirty three patients with AL were divided into 7 groups, such as AML-M_1-M_5, other AML and ALL. The experimental indexes and CDSS scores of all AL groups were compared and analyzed in pairs, meanwhile 100 healthy persons were taken in the control group. Clinical events such as early death in all cases were also analyzed. Results:The highest positive rate of Platelet was 59.76%, among the 5 experimental indexes, followed by D-D(30.93%), and the lowest APTT with only 2.70%. Compared with the control group, the differences of remaining indexes were statistically significant(P<0.01), except APTT in group AML-M3 and FIB in the other AML groups. The score of laboratory index was(1.50 ± 1.51) in all AL patients, and the positive rate of overt DIC( score ≥ 4) was 14.11%( 47 cases). The highest score of CDSS was(3.34 ± 1.71) in group AML-M3. The difference in the incidence of early death and cerebral(pulmonary) hemorrhage in DIC patients were statistically significant(P<0.05 and P<0.01). Conclusion: The application of quantitative integral method of experimental indexes in CDSS is objective and feasible, which is of great significance for early diagnosis and early treatment of acute leukemia complicated with DIC.
Objective: To analyze the 5 experimental indexes of CDSS in the patients with acute leukemia(AL) so as to provide the laboratorial basis for the early diagnosis and treatment of the secondary DIC in AL. Methods: Three hundred and thirty three patients with AL were divided into 7 groups, such as AML-M_1-M_5, other AML and ALL. The experimental indexes and CDSS scores of all AL groups were compared and analyzed in pairs, meanwhile 100 healthy persons were taken in the control group. Clinical events such as early death in all cases were also analyzed. Results:The highest positive rate of Platelet was 59.76%, among the 5 experimental indexes, followed by D-D(30.93%), and the lowest APTT with only 2.70%. Compared with the control group, the differences of remaining indexes were statistically significant(P<0.01), except APTT in group AML-M3 and FIB in the other AML groups. The score of laboratory index was(1.50 ± 1.51) in all AL patients, and the positive rate of overt DIC( score ≥ 4) was 14.11%( 47 cases). The highest score of CDSS was(3.34 ± 1.71) in group AML-M3. The difference in the incidence of early death and cerebral(pulmonary) hemorrhage in DIC patients were statistically significant(P<0.05 and P<0.01). Conclusion: The application of quantitative integral method of experimental indexes in CDSS is objective and feasible, which is of great significance for early diagnosis and early treatment of acute leukemia complicated with DIC.
引文
1中华医学会血液学分会血栓与止血学组.弥散性血管内凝血诊断中国专家共识(2017年版).中华血液学杂志,2017;38(5):361-363.
2中华医学会急诊医学分会,中华危重病急救医学杂志编辑委员会,脓毒症并发弥散性血管内凝血诊治急诊专家共识专家组.脓毒症并发弥散性血管内凝血诊治急诊专家共识.中华危重病急救医学,2017;29(7):577-580.
3严思棋,郭涛.血液系统疾病合并弥散性血管内凝血的诊断与治疗.临床血液学杂志,2018;31(01):1-4.
4许燕京,朱然,孙旖旎,等.抗凝血酶Ⅲ对脓毒症DIC的早期诊断价值:附445例患者的回顾性分析.中华危重病急救医学,2017;29(2):127-132.
5 Wu Y,Luo L,Niu T,et al.Evaluation of the new Chinese disseminated intravascular coagulation scoring system in critically ill patients:a multicenter prospective study.Sci Rep,2017;7(1):9057.
6 Toh CH,Alhamdi Y,Abrams ST.Current pathological and laboratory considerations in the diagnosis of disseminated intravascular coagulation.Ann Lab Med,2017;36(6):505-512.
7 Wada H,Thachil J,Di Nisio M,et al,Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines.J Thromb Haemost,2013;doi:10.1111/jth.12155.
8 Chang H,Kuo MC,Shih LY,et al.Clinical bleeding events and laboratory coagulation profiles in acute promyelocytic leukemia.Eur J Haematol,2012;88(4):321-328.
9 Wada H,Gabazza EC,Asakura H,et al.Comparison of diagnostic criteria for disseminated intravascular coagulation(DIC):Diagnostic criteria of the international society of thrombosis and hemostasis(ISTH)and of the Japanese ministry of health and welfare for overt DIC.Am J Hematol,2003;74(1):17-22.
10 Lee HJ,Park HJ,Kim HW,et al.Comparison of laboratory characteristic between acute promyelocytic leukemia and other subtypes of acute myeloid leukemia with disseminated intravascular coagulation.Blood Res,2013;48(4):250-253.
11肖芳芳,胡锴勋,郭梅,等.初诊急性白血病凝血指标异常及其临床意义探讨.中国实验血液学志,2013:21(2):300-304.
12 Levi M,Toh CH,Thachil J,et al.Guidelines for the diagnosis and management of disseminated intravascular coagulation.British Committee for Standards in Haematology.Br J Haematol,2009;145(1):24-33.
2中华医学会急诊医学分会,中华危重病急救医学杂志编辑委员会,脓毒症并发弥散性血管内凝血诊治急诊专家共识专家组.脓毒症并发弥散性血管内凝血诊治急诊专家共识.中华危重病急救医学,2017;29(7):577-580.
3严思棋,郭涛.血液系统疾病合并弥散性血管内凝血的诊断与治疗.临床血液学杂志,2018;31(01):1-4.
4许燕京,朱然,孙旖旎,等.抗凝血酶Ⅲ对脓毒症DIC的早期诊断价值:附445例患者的回顾性分析.中华危重病急救医学,2017;29(2):127-132.
5 Wu Y,Luo L,Niu T,et al.Evaluation of the new Chinese disseminated intravascular coagulation scoring system in critically ill patients:a multicenter prospective study.Sci Rep,2017;7(1):9057.
6 Toh CH,Alhamdi Y,Abrams ST.Current pathological and laboratory considerations in the diagnosis of disseminated intravascular coagulation.Ann Lab Med,2017;36(6):505-512.
7 Wada H,Thachil J,Di Nisio M,et al,Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines.J Thromb Haemost,2013;doi:10.1111/jth.12155.
8 Chang H,Kuo MC,Shih LY,et al.Clinical bleeding events and laboratory coagulation profiles in acute promyelocytic leukemia.Eur J Haematol,2012;88(4):321-328.
9 Wada H,Gabazza EC,Asakura H,et al.Comparison of diagnostic criteria for disseminated intravascular coagulation(DIC):Diagnostic criteria of the international society of thrombosis and hemostasis(ISTH)and of the Japanese ministry of health and welfare for overt DIC.Am J Hematol,2003;74(1):17-22.
10 Lee HJ,Park HJ,Kim HW,et al.Comparison of laboratory characteristic between acute promyelocytic leukemia and other subtypes of acute myeloid leukemia with disseminated intravascular coagulation.Blood Res,2013;48(4):250-253.
11肖芳芳,胡锴勋,郭梅,等.初诊急性白血病凝血指标异常及其临床意义探讨.中国实验血液学志,2013:21(2):300-304.
12 Levi M,Toh CH,Thachil J,et al.Guidelines for the diagnosis and management of disseminated intravascular coagulation.British Committee for Standards in Haematology.Br J Haematol,2009;145(1):24-33.