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目的:探讨急性白血病(AL)患儿并发弥散性血管内凝血(DIC)早期及干预后血凝指标变化。方法:本实验分3组即健康对照组;AL组;AL并发DIC组,均于清晨抽取空腹血检测D-二聚体(DD)、纤维蛋白原水平(FBG)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)及抗凝血酶-Ⅲ(AT-Ⅲ)。对AL并发DIC组患儿应用低分子肝素治疗,比较治疗前后各指标变化,采用SPSS10.0软件将各组进行统计学分析。结果:AL组与健康对照组比较,PT延长,FBG降低,DD明显升高,差异有统计学意义(P<0.05),AL并发DIC组与AL组比较,DD明显升高,AT-Ⅲ降低,差异有统计学意义(P<0.05),且与AL组相比,AL并发DIC组DD、AT-Ⅲ阳性率明显升高,且在DIC发病的不同临床阶段均保持在较高水平(80%以上),DD检测阳性率在血栓形成期高达100%。经肝素抗凝治疗后,AT-Ⅲ及FBG明显升高,DD降低,差异有统计学意义(P<0.05)。结论:AL并发DIC患儿存在凝血、纤溶系统的激活,AT-Ⅲ及DD可作为DIC早期诊断的指标,低分子肝素应用有助于改善DIC患儿的预后。
Objective: To investigate the changes of hemagglutination index in children with acute leukemia (AL) after disseminated intravascular coagulation (DIC) and early intervention. Methods: The experimental group was divided into 3 groups: healthy control group, AL group and AL complicated with DIC group. Fasting blood samples of D-dimer (DD), fibrinogen level (FBG), activated partial thromboplastin time (APTT), prothrombin time (PT) and antithrombin-Ⅲ (AT-Ⅲ). The patients with AL complicated with DIC were treated with low molecular weight heparin, and the changes of each index before and after treatment were compared. The data were analyzed by SPSS10.0 software. Results: Compared with the healthy control group, the PT, the FBG decreased and the DD increased significantly in the AL group (P <0.05). Compared with the AL group, the DD increased significantly and the AT-Ⅲ decreased (P <0.05). Compared with AL group, the positive rates of DD and AT-Ⅲ in AL complicated with DIC were significantly higher than those in AL group, and remained high at different clinical stages of DIC %), DD detection positive rate in thrombosis up to 100%. After heparin anticoagulant therapy, AT-Ⅲ and FBG were significantly increased, DD decreased, the difference was statistically significant (P <0.05). CONCLUSIONS: There is coagulation and fibrinolytic activation in children with AL complicated with DIC. AT-Ⅲ and DD can be used as early diagnostic indicators of DIC. The application of LMWH can improve the prognosis of children with DIC.