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本研究观察血管性血友病因子裂解蛋白酶(ADAMTS13)活性和血管性血友病因子(v WF)抗原在急性髓系白血病(AML)患者治疗前后的变化情况,探讨相关的临床意义。收集73例初治AML患者缓解前后的血浆标本,荧光标记v WF73底物荧光共振能量转移试验(FRETS-v WF73)检测患者血浆中的ADAMTS13活性,以ELISA试剂盒检测v WF抗原量。结果表明,初治AML患者治疗缓解前的ADAMTS13活性明显低于正常对照组:(63.3±25.5)%vs(105.1±37.7)%,(P<0.01);v WF抗原则高于正常对照组(226.6±127.0)%vs(111.4±39.7)%,(P<0.01)。经标准诱导化疗后缓解期患者的ADAMTS13活性明显高于治疗前组(P<0.01),与正常对照组比较无显著差异;v WF抗原则明显低于治疗前组(P<0.01),但仍高于正常对照组(P<0.05)。初治AML患者治疗前合并感染者的ADAMTS13活性明显低于无感染组:(52.2±20.6)%vs(73.9±24.7)%,(P<0.01);感染组v WF抗原明显高于无感染组:(262.2±135.7)%vs(193.8±110.2)%,(P<0.05)。伴弥散性血管内凝血(DIC)者的ADAMTS13活性明显低于无DIC组:(42.0±14.5)%vs(73.4±22.7)%,(P<0.01);DIC患者的v WF抗原明显高于无DIC组:(274.2±140.0)%vs(204.7±115.5)%,(P<0.05)。结论:初治AML患者治疗前伴有ADAMTS13活性的降低和v WF的升高,以合并感染和DIC的患者表现最显著。ADAMTS13和v WF在肿瘤的发生发展,炎症和DIC的形成过程中起一定作用。
This study was to observe the changes of ADAMTS13 activity and vWF antigen in patients with acute myeloid leukemia (AML) before and after treatment, and to explore the clinical significance. Plasma samples were collected before and after remission in 73 newly diagnosed AML patients. Fluorescence resonance energy transfer assay (FRETS-v WF73) was used to detect ADAMTS13 activity in plasma of patients with newly diagnosed AML. ELISA was used to detect the amount of vWF antigen. The results showed that the activity of ADAMTS13 in untreated AML patients was significantly lower than that of the normal control group (63.3 ± 25.5)% vs (105.1 ± 37.7)%, (P <0.01), and the level of vWF antigen was higher than that of the normal control group 226.6 ± 127.0)% vs (111.4 ± 39.7)%, (P <0.01). The ADAMTS13 activity of remission patients after standard induction chemotherapy was significantly higher than that before treatment (P <0.01), there was no significant difference compared with the normal control group; v WF antigen was significantly lower than the pre-treatment group (P <0.01) Higher than the normal control group (P <0.05). The activity of ADAMTS13 in patients with newly diagnosed AML before treatment was significantly lower than that in non-infected patients (52.2 ± 20.6)% vs (73.9 ± 24.7)%, (P <0.01). The vWF antigen in infected patients was significantly higher than that in non-infected patients : (262.2 ± 135.7)% vs (193.8 ± 110.2)%, (P <0.05). ADAMTS13 activity in patients with disseminated intravascular coagulation (DIC) was significantly lower than that in patients without DIC (42.0 ± 14.5)% vs (73.4 ± 22.7)%, (P <0.01); vWF antigen was significantly higher in patients with DIC than in patients without DIC DIC group: (274.2 ± 140.0)% vs (204.7 ± 115.5)%, (P <0.05). Conclusions: The reduction of ADAMTS13 activity and the increase of v WF in newly diagnosed AML patients before treatment are the most significant in patients with combined infection and DIC. ADAMTS13 and v WF play a role in tumor development, inflammation and DIC formation.