论文部分内容阅读
目的 观察急性早幼粒细胞白血病 (APL)患者发病时、全反式维甲酸 (ATRA)和三氧化二砷(As2 O3 )治疗期间的止、凝血改变。方法 运用ELISA或发色底物法对 2 3例APL患者血浆一系列止、凝血指标进行动态检测。结果 治疗前血浆血栓调节蛋白 (TM )、血小板α颗粒膜蛋白 (GMP 140 )、可溶性纤维蛋白单体复合物、组织因子途径抑制物、组织纤溶酶原激活物活性 (t PA)和D 二聚体较正常组显著升高 ;纤维蛋白原、蛋白C(PC)抗原、纤溶酶原、α2 抗纤溶酶和纤溶酶原激活抑制物低于正常 ;PC活性 (PC∶A)和蛋白S抗原与正常组无显著差异。TM和GMP 140与患者发病时白细胞计数有关。ATRA及As2 O3 治疗缓解后除PC∶A部分增高外余均恢复至正常范围内。ATRA组TM、PC∶A和t PA有所升高 ,在As2 O3 组未发现上述现象。结论 APL发病过程中存在血管内皮细胞损伤、血小板活化以及凝血、抗凝、纤溶系统的激活 ,ATRA和As2 O3 治疗早期即能明显改善APL的止、凝血异常
Objective To observe the changes of coagulation and hemostasis during the treatment of APL in patients with ATRA and As2O3. Methods ELISA or chromogenic substrate method was used to dynamically detect plasma coagulation parameters in 23 patients with APL. Results Pretreatment plasma thrombomodulin (TM), platelet alpha granule membrane protein (GMP 140), soluble fibrin monomer complex, tissue factor pathway inhibitor, tissue plasminogen activator activity (t PA) and D II The aggregates were significantly higher than the normal group; fibrinogen, protein C (PC) antigen, plasminogen, α2 antiplasmin, and plasminogen activation inhibitor were lower than normal; PC activity (PC:A) and There was no significant difference between protein S antigen and normal group. TM and GMP 140 are related to the leukocyte count at the onset of the patient. After the remission of ATRA and As2O3, all but PC:A elevations were restored to the normal range. ATRA group TM, PC: A, and t PA were elevated, and no such phenomenon was observed in the As2O3 group. Conclusion There are vascular endothelial cell damage, platelet activation and activation of coagulation, anticoagulation and fibrinolytic system in the pathogenesis of APL. ATRA and As2O3 treatment can significantly improve APL and coagulation abnormalities in the early stage.