初诊243例急性白血病凝血等指标检测临床价值
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摘要
目的探讨急性白血病(AL)初诊患者中6项凝血指标及白细胞(WBC)、血小板(PLT)检测的临床价值。方法回顾性分析2012年1月至2018年6月到昆明医科大学第六附属医院诊治的243例AL患者临床资料(其中AML非M3型135例,AML-M3型43例,ALL 65例)临床资料,对患者初诊时6项凝血指标(凝血酶原时间(PT)、纤维蛋白原(Fbg)、活化部分凝血活酶时间(APTT)、血浆抗凝血酶Ⅲ活性(ATⅢ)、纤维蛋白(原)降解产物(FDP)、D-二聚体(D-D))和白细胞(WBC)、血小板(PLT)等检测结果进行统计分析。结果(1) 243例AL患者有1项及以上凝血指标异常者215例(88.48%),6项凝血指标检测异常率依次为:D-D64.65%(139/215)、 Fbg 56.38%(137/243)、 FDP 52.63%(80/152)、 PT 48.56%(118/243)、 APTT 38.68%(94/243)、ATⅢ29.87%(46/154);226例血常规检查WBC在0.12×109/L～792.97×109/L之间,PLT在2.0×109/L～478.0×109/L之间;(2)与ALL组比较,AML非M3组和AML-M3组均存在PT明显延长,而FDP、PLT明显降低;(3) 243例AL中有144例(59.26%)出血,其中有凝血指标异常者134例(55.14%),占出血总数的93.06%,以AML-M3型(65.11%)最高,但各类型AL组间比较出血发生率差异无统计学意义(P> 0.05);出血发生率随凝血指标异常项的增加而增加,且加重,且≥3项异常组比较0项组、1项异常组出血发生差异均有统计学意义(χ~2=10.39,P <0.01;χ~2=3.89,P<0.05)。有凝血指标异常比较无凝血指标异常出血发生率有统计学意义(χ~2=7.27,P <0.01);(4) WBC分组的出血发生率以WBC≥60.0×109/L组较高(69.70%),2级出血占54.55%,但组间比较出血发生率差异无统计学意义(P> 0.05)。PLT分组中出血发生率以PLT≤30.0×109/L组最高,且与其余组比较差异均有统计学意义(P <0.05)。结论初诊AL患者凝血指标异常率较高,且以D-D最敏感,出血发生率随凝血指标异常项增多和血小板的减少而增加并加重。
Objective To investigate the values of six coagulation indexes, white cell(WBC) and platelet(PLT) in patients initially diagnosed with acute leukemia(AL). Methods The data of PT, Fbg, APTT, AT III, FDP, D-D, WBC and PLT were collected, arranged and analyzed in 243 patients with AL from January2012 to January 2018(135 cases of AML non M3, 43 cases of AML-M3 and ALL65 cases). Re s ults(1)Among the 243 cases of AL patients, 215 cases(88.48%) had 1 and more abnormal coagulation indexes, in,the abnormal rates of six coagulation indexes were in turn: D-D 64.65%(139/215), Fbg 56.38%(137/243),FDP 52.63%(80/152),PT 48.56%(118/243), APTT 38.68%(94/243), ATⅢ 29.87%(46/154);blood routine examination of 226 cases showed that WBC was between 0.12×109/L to 792.97×109/L and PLT was between2.0 ×109/L to 478.0 ×109/L;(2) Compared with ALL group, PT value extended in AML Non M3 group and AML-M3 group, while FDP and PLT decreased significantly;(3) Of the 243 patients with AL, 144(59.26%) had bleeding, the incidence of bleeding in different types of AL was the highest in AML-M3 type(65.11%), but there was no significant difference in the incidence of bleeding among the various types of AL groups; The bleeding rate in 243 AL patients increased and aggravated with the increase of abnormal blood coagulation index, 3 and above group was statistically significant with other groups;(4) The group with WBC higher than 60.0 ×109/L had the highest incidence of bleeding(69.70%), and grade 2 bleeding accounted for54.55%. However, there was no significant difference in the incidence of bleeding between groups(P > 0.05).The group with PLT lower than 30.0 ×109/L had statistical significance in incidence of bleeding with other three groups. Conclus ion The abnormal rates of coagulation indexes are higher in newly diagnosed AL patients, and D-D is the most sensitive index. The incidence of bleeding increases with the increase of abnormal coagulation indexs and the decrease of PLT.
Objective To investigate the values of six coagulation indexes, white cell(WBC) and platelet(PLT) in patients initially diagnosed with acute leukemia(AL). Methods The data of PT, Fbg, APTT, AT III, FDP, D-D, WBC and PLT were collected, arranged and analyzed in 243 patients with AL from January2012 to January 2018(135 cases of AML non M3, 43 cases of AML-M3 and ALL65 cases). Re s ults(1)Among the 243 cases of AL patients, 215 cases(88.48%) had 1 and more abnormal coagulation indexes, in,the abnormal rates of six coagulation indexes were in turn: D-D 64.65%(139/215), Fbg 56.38%(137/243),FDP 52.63%(80/152),PT 48.56%(118/243), APTT 38.68%(94/243), ATⅢ 29.87%(46/154);blood routine examination of 226 cases showed that WBC was between 0.12×109/L to 792.97×109/L and PLT was between2.0 ×109/L to 478.0 ×109/L;(2) Compared with ALL group, PT value extended in AML Non M3 group and AML-M3 group, while FDP and PLT decreased significantly;(3) Of the 243 patients with AL, 144(59.26%) had bleeding, the incidence of bleeding in different types of AL was the highest in AML-M3 type(65.11%), but there was no significant difference in the incidence of bleeding among the various types of AL groups; The bleeding rate in 243 AL patients increased and aggravated with the increase of abnormal blood coagulation index, 3 and above group was statistically significant with other groups;(4) The group with WBC higher than 60.0 ×109/L had the highest incidence of bleeding(69.70%), and grade 2 bleeding accounted for54.55%. However, there was no significant difference in the incidence of bleeding between groups(P > 0.05).The group with PLT lower than 30.0 ×109/L had statistical significance in incidence of bleeding with other three groups. Conclus ion The abnormal rates of coagulation indexes are higher in newly diagnosed AL patients, and D-D is the most sensitive index. The incidence of bleeding increases with the increase of abnormal coagulation indexs and the decrease of PLT.
引文
[1]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[J].中国实验血液学杂志,2013,21(2):301-302.
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[5] KIMD Y,LEE J H,LEE J H,et al. Significance of fibrinogen,d-dimer,and ldh levels in predicting the risk of bleeding in patients with acute promyelocytic leukemia[J].Leuk Res,2011,35(2):152-158.
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[7]曹江涛,郑雅茹,赵世峰.国际血栓与止血协会标准评分与日本卫生福利部标准评分对危重症患者弥漫性血管内凝血的诊断价值比较[J].实用心脑肺血管病杂志,2018,26(09):75-78.
[8] TAKAHASHI G,SHIBATA S,ISHIKURA H,et al. Presepsin in the prognosis of infectious diseases and diagnosis of infectious disseminated intrazascuiar coagulation:a prospective,multicentre,observational study[J]. EJA,2015,32(3):199-206.
[9]邓丽,刘宏宇,李欣.对体外生命支持组织的抗凝指南解读[J].中国体外循环杂志,2017,15(02):72-75.
[10]张之南,郝玉书,赵永强,等.血液病学[M].第2版.北京:人民卫生出版社,2015:749.
[11] QUINTERO J,ORTEGA J,MISERACHS M,et al. Low plasma levels of antithrombin III in the early post-operative period following pediatric liver transplantation:should they be replaced? A single-center pilot study[J]. Pediatr Transplant,2014,18(2):185-189.
[12]郑润辉,于宝丹,郑丽霞,等.急性白血病患者T细胞亚群的变化及其与临床特征和预后的关系[J].中国实验血液学杂志,2018,26(05):1309-1316.
[13]SCHWAMEIS M,SCHOBER A,SCHORGENHOFER C,et al.Asphyxia by drowning induces massive bleeding due to hyperfibrinolytic disseminated intravascular coagulation[J].Crit Care Med,2015,43(11):2394-2402.
[14]许勇臣.骨髓细胞和血小板参数联合检测对血液疾病的诊断价值分析[J].世界最新医学信息文摘,2018,18(39):30-31.
[2]张之南,沈悌.血液病诊断及疗效标准[M].第3版,北京:科学出版社,2007:19-232.
[3]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)[J].中华血液学杂志,2017,38(5):362-364.
[4]唐晓钰.初发急性白血病患者的凝血指标异常状况分析[J].实用癌症杂志,2015,30(3):416-417.
[5] KIMD Y,LEE J H,LEE J H,et al. Significance of fibrinogen,d-dimer,and ldh levels in predicting the risk of bleeding in patients with acute promyelocytic leukemia[J].Leuk Res,2011,35(2):152-158.
[6] SHAHMARVAND N,OAK J S,CASCIO MJ,et al. A study of disseminated intravascular coagulation in acute leukemia reveals markedly elevated D-dimer levels are a sensitive indicator of acute promyelocytic leukemia[J]. Int J Lab Hematol,2017,39(4):375-383.
[7]曹江涛,郑雅茹,赵世峰.国际血栓与止血协会标准评分与日本卫生福利部标准评分对危重症患者弥漫性血管内凝血的诊断价值比较[J].实用心脑肺血管病杂志,2018,26(09):75-78.
[8] TAKAHASHI G,SHIBATA S,ISHIKURA H,et al. Presepsin in the prognosis of infectious diseases and diagnosis of infectious disseminated intrazascuiar coagulation:a prospective,multicentre,observational study[J]. EJA,2015,32(3):199-206.
[9]邓丽,刘宏宇,李欣.对体外生命支持组织的抗凝指南解读[J].中国体外循环杂志,2017,15(02):72-75.
[10]张之南,郝玉书,赵永强,等.血液病学[M].第2版.北京:人民卫生出版社,2015:749.
[11] QUINTERO J,ORTEGA J,MISERACHS M,et al. Low plasma levels of antithrombin III in the early post-operative period following pediatric liver transplantation:should they be replaced? A single-center pilot study[J]. Pediatr Transplant,2014,18(2):185-189.
[12]郑润辉,于宝丹,郑丽霞,等.急性白血病患者T细胞亚群的变化及其与临床特征和预后的关系[J].中国实验血液学杂志,2018,26(05):1309-1316.
[13]SCHWAMEIS M,SCHOBER A,SCHORGENHOFER C,et al.Asphyxia by drowning induces massive bleeding due to hyperfibrinolytic disseminated intravascular coagulation[J].Crit Care Med,2015,43(11):2394-2402.
[14]许勇臣.骨髓细胞和血小板参数联合检测对血液疾病的诊断价值分析[J].世界最新医学信息文摘,2018,18(39):30-31.