急性髓系白血病中ADAMTS13活性和vWF的水平变化及其意义  

Changes of ADAMTS13 Activity and vWF Antigen Level in Patients with Acute Myelogenous Leukemia and Their Significance

作　　者：张文娟[1] 韩悦[1] 马珍妮[1] 王倩[1] 唐雅琼 王杰[1] 苏健[1] 孙爱宁[1] 王兆钺[1] 阮长耿[1] 吴德沛[1] 

机构地区：[1]苏州大学附属第一医院血液科,江苏省血液研究所,卫生部血栓与止血重点实验室,江苏苏州215006

出　　处：《中国实验血液学杂志》2014年第6期1503-1507,共5页Journal of Experimental Hematology

基　　金：国家自然科学基金(81270591);江苏省医学重点人才项目(RC2011105);江苏省"333工程"科研项目(BRA2011218);江苏省临床医学中心资助(ZX201102)

摘　　要：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 purposed to investigate the changes of von Willebrand factor cleaving protease（ADAMTS13） activity and vWF antigen level in patients with acute myelogenous leukemiaAMLbefore and after treatment and evaluate their clinical significance.Seventy-three AML patients were enrolled in this studythe sodium citrate anticoagulated plasma was collected before and after their induction chemotherapy.Fluorescence resonance energy transfer substrate vWF73（ FRETS-vWF73 ）assay was established to detect the plasma ADAMTS13 activity while vWF antigen level was measured by ELISA.The results showed that the ADAMTS13 activity in newly diagnosed patients with AML before induction therapy was obviously lower than that in normal controls（63.3 ± 25.5）% vs（ 105.1 ± 37.7）（ P〈0.01）,while the vWF antigen level was higher than that in normal controls（226.6 ± 127.0）% vs（ 111.4 ± 39.7）%（ P〈0.01）.After standard induction chemotherapythe ADAMTS13 activity of AML patients in complete remission period was higher than that in AML patients before therapy（P〈0.01）,and was not significant difference with that in normal controlsthe vWF antigen was significantly lower than that in AML patients before therapy（P〈0.01）,but it still was higher than that in controls（ P〈0.05）.The ADAMTS13 activity in newly diagnosed AML patients complicated with infection befor therapy was obviously lower than that in AML patients without infection（ 52.2 ± 20.6）% vs（ 73.9 ± 24.7）%（P〈0.01）,while the vWF antigen level was significantly higher than that in AML patients without infection（ 262.2 ± 135.7）% vs（ 193.8 ± 110.2）%（ P〈0.05）.The ADAMTS13 activity in AML patients with disseminated intravascular coagulation（ DICwas significantly lower than that in AML patients without DIC（ 42.0 ±14.5）% vs（ 73.4 ± 22.7）%（ P〈0.01）,while the vWF antigen level was obviously higher that in AML patients without DIC（274.2 ± 140.0）% vs（ 204.7 ± 115.5%（ P〈0.01）.It is c

关 键 词：血管性血友病因子裂解蛋白酶 血管性血友病因子 急性髓系白血病 感染 弥散性血管内凝血 

分 类 号：R733.71[医药卫生—肿瘤]