急性白血病并发前DIC的分子标志物诊断  

Diagnosis of pre-disseminated intravascular coagulation by hemostatic molecular markers in acute leukemic patients

作　　者：吴方[1] 王学锋[1] 璩斌[1] 陈钰[1] 沈志祥[1] 王鸿利[1] 

机构地区：[1]上海第二医科大学附属瑞金医院上海血液研究所,200025

出　　处：《上海医学》2002年第3期164-166,共3页Shanghai Medical Journal

摘　　要：目的　观察急性白血病 (AL)止凝血分子标志物的变化以探索其在前DIC (pre DIC)诊断中的意义。方法　用ELISA法检测 81例AL患者血浆组织因子 (TF)、组织因子途径抑制物 (TFPI)、凝血酶 抗凝血酶复合物 (TAT)、纤溶酶 抗纤溶酶复合物 (PAP)、D 二聚体 (D D)含量。结果　pre DIC患者血浆TAT、TF、PAP、D D水平显著高于对照组 ,TFPI在两组间无显著差异 ;急性早幼粒细胞白血病 (APL)并发pre DIC者PAP值增高尤为显著。TAT、PAP、D D对 pre DIC诊断的灵敏度分别为 88.6 %、97.1%、85 .7% ;特异性为 6 9.6 %、76 .1%、89.1% ;联合应用 3个指标 ,其灵敏度为 80 .0 % ,特异性为 95 .7%。发生DIC者TF持续增高。结论　TAT、PAP、D D对 pre DIC的诊断有重要意义 ;多项分子标志物的联合应用 ,可提高pre DIC的确诊率。TAT/PAP的监测有助于临床上对DIC治疗效果的判断及抗凝、抗纤溶药物的应用和调整。Objective To study the changes of hemostatic molecular markers in acute leukemia(AL) patients, for elucidating their significance on diagnosis of pre disseminated intravascular coagulation(pre DIC). Methods A number of hemostatic molecular markers, including TAT、TF、TFPI、PAP and D D were measured by ELISA methods in 81 acute leukemia patients. Results Plasma levels of TAT、TF、PAP、D D were significantly higher than in those without patients, while PAP level was markedly elevated in APL patients with pre DIC. The sensitivity of TAT、PAP and D D for the diagnosis of pre DIC were 88.5% 、97.14%、85.75, whereas the specificity were 69.57%、 76.09% and 89.13%. By combination of the results of TAT、PAP and D D, the sensitivity was 80% and the specificity was 95.56%. Plasma levels of TF remained at high levels in patients who developed DIC. Conclusion The hemostatic molecular markers TAT、PAP and D D were useful for the diagnosis of pre DIC, while combinations of hemostatic molecular markers increase the specificity of its diagnosis. TF is an important marker to predict the development and prognosis of DIC. TAT/PAP ratio may be helpful in the proper management of patients with DIC and during the use of antithrombin and/or antifibrinolytic agents.

关 键 词：弥散性血管内凝血 急性白血病 诊断 

分 类 号：R733.7[医药卫生—肿瘤]