急性白血病并弥散性血管内凝血患儿凝血与纤溶功能变化的意义  

Changes of Blood Coagulation and Fibrinolysis Function in Acute Leukemia Children Complicated with Disse-minated Intravascular Coagulation and Their Significances

作　　者：杨锐[1] 张志泉[2] 魏文宁[1] 杨焰[1] 宋善俊[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院血液科,武汉430022 [2]华中科技大学同济医学院附属协和医院儿科,武汉430022

出　　处：《实用儿科临床杂志》2008年第18期1430-1431,1434,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的观察急性白血病（AL）并弥散性血管内凝血（DIC）患儿抗凝血酶活性（AT）、D-二聚体等的变化及其关系，以探讨患儿凝血、纤溶功能变化。方法选择AL未并DIC患儿27例（AL组），AL并DIC患儿25例（观察组），健康儿童36例作为健康对照组。均抽取其清晨空腹静脉血1．8mL，离心分离血清。应用发色底物法、免疫学胶乳比浊法及凝固法分别检测AT、D-二聚体、纤维蛋白原水平、活化部分凝血活酶时间、凝血酶原时间。采用SPSS 10．0软件将AL组和观察组结果与健康对照组进行统计学比较。结果AL组患儿PT延长、D-二聚体水平明显升高，与健康对照组比较，差异均有显著性意义（Pa〈0．01）；观察组D-二聚体水平明显增高，AT明显减低，与健康对照组和AL组比较，差异均有显著性意义（Pa〈0．01）；AL组各项检测指标阳性率较低（18．5％-66．7％），观察组D-二聚体、AT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％-100％），D-二聚体检测阳性率在DIC早期高达100％。结论AL并DIC患儿存在凝血、纤溶系统的激活，各凝血指标特别是AT和D-二聚体的检测可作为DIC诊断和预后评估的指标之一。Objective To observe the changes of antithrombin activity （AT） and D - dimer in acute leukemia（AL） children complicated with disseminated intravascular coagulation （DIC） and to explore the changes of blood coagulation and fibrinolysis function. Methods Twenty - seven AL children without DIC were selected as AL group and 25 childern complicated with DIC were selected as observe group,36 health children were as control group. Plasma level of AT, D - dimer, fibrinogen, activated partial thromboplastin time and prothrombin time were tested by color substrate,immuno - latex turbidimetry, and coagulation method. And the rusults of AL group were compared with observe group and control group by SPSS 10.0 software. Results PT was significantly prolonged and the D - dimer in AL group and observation group were significantly higher than those in control group（ Po 〈 0.01 ）. The plasma level of D - dimer in observe group was significantly higher and the activities of AT was significantly lower than those in control group or AL group （Pa 〈 0.01 ）. Sensitivities of each detection in AL group was lower （ 18.5% - 66.7% ） than observe group（ 80% - 100% ）. Especially the sensitivities of the D - dimer was 100% in the earlier period of DIC. Conclusions AL children complicated with DIC has important impacts on coagulation and fibrinolysis function. Parameters,especially AT and D - dimer ,may be used for diagnosis of DIC and evaluation of the prognosis.

关 键 词：弥散性血管内凝血 急性白血病 D-二聚体 抗凝血酶活性 儿童 

分 类 号：R733.71[医药卫生—肿瘤] R725.5[医药卫生—临床医学]