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目的:通过检测急性髓系白血病(AML)患者血浆中组因子(TF)及组织因子微粒(MP-TF)的表达,探讨其在AML凝血异常中的临床意义。方法:选择AML住院患者64例(AML组),其中急性早幼粒细胞白血病(APL)22例,非APL 42例;并发弥散性血管内凝血(DIC)22例,未并发DIC 42例。非APL中13例治疗后骨髓完全缓解(CR),APL中15例治疗后骨髓达CR,包含12例APL并发DIC患者。对照组34例均为健康献血员。采用流式细胞术检测MP-TF,ELISA法检测血浆中TF。结果:治疗前AML组MP-TF及TF水平明显高于对照组[(60.90±14.90)%∶(45.80±12.03)%,P<0.01;(129.11±37.32)pg/ml∶(95.96±19.56)pg/ml,P<0.05]。AML组内,15例治疗后骨髓达CR的APL患者治疗前后MP-TF水平差异有统计学意义[(60.13±8.95)%∶(51.65±8.11)%,P<0.05],其中12例APL并发DIC患者治疗前MP-TF及TF水平均高于治疗后[(60.00±9.45)%∶(56.70±17.10)%;(155.67±31.14)pg/ml∶(122.03±18.41)pg/ml,均P<0.05];13例治疗后骨髓达CR的非APL患者治疗前TF明显高于治疗后[(147.61±27.43)pg/ml∶(118.73±20.23)pg/ml,P<0.01]。AML组内,凝血酶原时间(PT)延长>3s的患者(10例)MP-TF水平明显高于PT延长<3s及PT正常的患者(54例)[(64.10±9.38)%∶(59.40±19.73)%,P<0.05];纤维蛋白降解产物(FDP)异常的患者(24例)TF水平明显高于FDP正常患者(40例)[(152.26±37.89)pg/ml∶(112.81±35.47)pg/ml,P<0.05]。结论:MP-TF及TF是参与凝血异常的重要指标,MP-TF较血浆TF能更好地反映TF活性水平,且MP-TF与AML尤其是APL及其凝血异常有密切关系,可作为监测APL疾病病情缓解的有效指标之一。
Objective: To investigate the clinical significance of the levels of TF and MP-TF in the plasma of patients with acute myeloid leukemia (AML). Methods: Sixty-four patients with AML (AML group) were enrolled in this study. Among them, 22 were acute promyelocytic leukemia (APL) and 42 were non-APL. Twenty-two patients were complicated with diffuse intravascular coagulation (DIC) and 42 without DIC. Bone marrow was completely relieved (CR) in 13 of the non-APL patients and 15 of the APL patients had CR in the bone marrow, including 12 patients with APL complicated with DIC. The control group of 34 patients were healthy blood donors. MP-TF was detected by flow cytometry and TF in plasma was detected by ELISA. Results: The levels of MP-TF and TF in AML group before treatment were significantly higher than those in the control group [(60.90 ± 14.90)%: (45.80 ± 12.03)%, P <0.01, (129.11 ± 37.32) pg / ml:95.96 ± 19.56, pg / ml, P <0.05]. In the AML group, MP-TF levels in 15 APL patients with bone marrow CR before and after treatment were significantly different before and after treatment [(60.13 ± 8.95)% vs (51.65 ± 8.11)%, P <0.05] The levels of MP-TF and TF in patients with DIC before treatment were significantly higher than those before treatment [(60.00 ± 9.45)% vs (56.70 ± 17.10)%; (155.67 ± 31.14) pg / ml: (122.03 ± 18.41) pg / <0.05]. The TF before treatment in 13 non-APL patients with bone marrow up to CR after treatment was significantly higher than that after treatment [(147.61 ± 27.43) pg / ml: (118.73 ± 20.23) pg / ml, P <0.01]. In the AML group, MP-TF levels in patients with prolonged prothrombin time (PT)> 3 s were significantly higher than those in patients with PT prolongation <3 s and normal PT [(64.10 ± 9.38)%: (59.40 ± 19.73)%, P <0.05]. The level of TF in patients with FDP abnormality (24 cases) was significantly higher than that in normal FDP patients (40 cases) [(152.26 ± 37.89) pg / ml:112.81 ± 35.47 ) pg / ml, P <0.05]. CONCLUSION: MP-TF and TF are important indicators involved in coagulation abnormalities. MP-TF can reflect the level of TF activity better than plasma TF, and MP-TF is closely related to AML, especially APL and its coagulation abnormalities, APL disease one of the effective indicators of remission.