论文部分内容阅读
目的:检测不同类型急性白血病(AL)患者不同发展阶段AT-Ⅲ(抗凝血酶Ⅲ)、vWF(血管性血友病因子)、DD(D-二聚体)及VEGF(血管内皮生长因子)含量的变化,以探讨这些活性物质在AL患者的诊断、治疗及预后判断中的临床意义。方法:测定45例AL患者(其中AML30例,ALL15例)和30例健康对照组血浆AT-Ⅲ、vWF、DD及VEGF的含量,并对AL患者进行治疗前、后两个不同阶段的动态检测;同时将APL与其它类型的AL进行了对比观察。骨髓涂片在显微镜下按常规分类计数200个有核细胞,计算原始及幼稚细胞比例。结果:(1)AL患者初诊时血浆VEGF、vWF、DD含量均明显升高,而AT-Ⅲ含量明显减低,与正常对照组比较差异有统计学意义;(2)治疗前AL组中M3(急性早幼粒细胞白血病APL)组血浆DD与vWF水平较其他AL(M2、M4、M5)患者增高,而AT-Ⅲ水平减低,而M2(急性粒细胞白血病)、M4(急性粒-单核细胞白血病)、M5(急性单核细胞白血病)组与ALL组之间比较无显著性差异;VEGF含量与其他类型AL患者差异无统计学意义;(3)经过1~3个疗程的治疗后,达到CR(完全缓解)时,血浆AT-Ⅲ含量恢复正常,而VEGF、vWF及DD含量明显减低,与正常对照组比较均无显著差异;未达到缓解[包括部分缓解(PR)和未缓解(NR)]时,上述因子与治疗前比较差异无统计学意义;(4)AL初诊患者治疗前血浆VEGF、vWF及DD水平与骨髓原始加幼稚细胞数呈正相关,而AT-Ⅲ水平与骨髓始加幼稚细胞数呈负相关。结论:AL患者初诊时存在不同程度的内皮损伤、凝血和纤溶系统的激活,并随着病情的好转而改善。动态监测AL患者血浆DD、vWF、AT-Ⅲ及VEGF水平,可作为白血病凝血功能障碍的重要参考指标。
Objective: To detect AT-Ⅲ (antithrombin Ⅲ), vWF (von Willebrand factor), DD (D-dimer) and VEGF (vascular endothelial growth factor) in different stages of acute leukemia (AL) ) Content changes in order to explore the clinical significance of these active substances in the diagnosis, treatment and prognosis of AL patients. Methods: The plasma concentrations of AT-Ⅲ, vWF, DD and VEGF in 45 AL patients (30 AML cases, 15 ALL cases) and 30 healthy controls were measured, and the dynamic changes of AL in two different stages before and after treatment were detected At the same time, APL was compared with other types of AL. Bone marrow smears under the microscope according to the conventional classification of counting 200 nucleated cells, calculate the proportion of naive and naive cells. Results: (1) The plasma levels of VEGF, vWF and DD in patients with AL were significantly increased, while the content of AT-Ⅲ was significantly decreased in AL patients compared with the normal control group; (2) The levels of M3 The levels of plasma DD and vWF in patients with acute promyelocytic leukemia (APL) were higher than those in other patients with AL (M2, M4, M5), while the levels of AT-Ⅲ were lower in patients with acute promyelocytic leukemia, while the levels of M2 (acute granulocytic leukemia) Cell leukemia), M5 (acute monocytic leukemia) group and ALL group; there was no significant difference between VEGF and other AL patients; (3) After 1 to 3 courses of treatment, At CR (complete remission), plasma AT-Ⅲ levels returned to normal while levels of VEGF, vWF and DD were significantly decreased, with no significant difference from the normal control group; did not achieve remission [including partial remission (PR) (4) The plasma levels of VEGF, vWF and DD before treatment in newly diagnosed patients with AL were positively correlated with the number of naive plus naive cells, while the level of AT-Ⅲ was positively correlated with the level of bone marrow Plus naive cells was negatively correlated. CONCLUSIONS: There is varying degrees of endothelial damage, coagulation and fibrinolysis activation in AL patients at initial diagnosis and is improved as the condition improves. Dynamic monitoring of AL patients with plasma DD, vWF, AT-III and VEGF levels can be used as an important reference for coagulation disorders in leukemia.