白细胞清除术对高白细胞性白血病患者止血功能的影响  

Effects of Leukapheresis on Hemostatic Function in Patients with Hyperleukocytic Leukemia

作　　者：屠雨青 范祎[1] 宋铁梅[1] 朱子玲[1] 冯宇锋[1] 戴丽君[1] 常惠荣[1] 吴德沛[1] TU Yu-Qing;FAN Yi;SONG Tie-Mei;ZHU Zi-Ling;FENG Yu-Feng;DAI Li-Jun;CHANG Hui-Rong;WU De-Pei(Department of Hematology The First Affiliated Hospital of Soochow University,Jiangsu Institute of Hematology,National Clinical Research Center for Hematologic Diseases,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health,Suzhou 215006,Jiangsu Province,China)

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,国家血液系统疾病临床医学研究中心,国家卫生健康委员会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》2022年第2期361-366,共6页Journal of Experimental Hematology

基　　金：国家科技重大专项课题(2017ZX09304021);国家重点研发计划(2019YFC0840604,2017YFA0104502);江苏省重点研发计划(BE2019798);江苏省医学杰出人才项目(JCRCA2016002);江苏省科教强卫工程-临床医学中心(YXZXA2016002);苏州市科技计划项目(SLT201911)。

摘　　要：目的:分析比较不同高白细胞性白血病患者进行白细胞清除对止血功能的影响。方法:本研究纳入了2009年6月至2020年2月共139例行白细胞清除术且术前术后进行凝血指标检测的AML、ALL和CML患者,评估各组的清除效果和组间清除效率的差异,并通过血小板、凝血指标的变化、CDSS评分、不良事件发生率的计算,比较该技术在不同白血病患者中导致的止血功能差异。结果:三类患者白细胞清除术后,白细胞数均显著下降(P<0.001),以ALL患者清除效果最佳。白细胞清除术后患者的血小板数均显著下降(AML:P<0.001, ALL:P<0.001, CML:P<0.01),其中急性白血病患者的血小板下降风险更高,且下降幅度与白细胞清除效率呈正相关(r=0.284)。此外,清除术后患者纤维蛋白原降低,凝血酶原时间和活化部分凝血活酶时间均延长。急性白血病患者中,清除后CDSS评分较高的患者出血事件概率更高(P<0.05)。结论:白细胞清除术是高白细胞性白血病患者降低肿瘤负荷的有效手段,但仍需警惕其对止血功能的影响,急性白血病患者建议进行CDSS评分,以进一步明确其对出血事件预测意义。Objective: To analyze and compare the effects of leukapheresis on hemostatic function in patients with hyperleukocytic leukemia. Methods: A total of 139 patients with AML, ALL and CML who underwent leukapheresis from June 2009 to February 2020 and did coagulation test before and after operation were included in this study. The clearance efficiency of each group and the difference among three groups were evaluated, as well as hemostatic function including platelet counts, coagulation indicators, CDSS score and incidence of adverse events. The difference of hemostatic function caused by leukapheresis in different leukemia patients were compared. Results: After leukapheresis, the WBC counts were decreased significantly in the three groups of patients(P<0.001), and the clearance efficiency was highest in ALL patients. However, the platelet counts also were decreased significantly(AML:P<0.001, ALL: P<0.001, CML: P<0.01) in the three groups of patients, particularly for acute leukemia patients with a positive correlation with WBC clearance efficiency(r=0.284). After leukapheresis, fibrinogen decreased, PT and APTT prolonged. For acute leukemia patients, higher CDSS score was related to an elevated incidence of bleeding events(P<0.05). Conclusion: Leukapheresis is an effective method to decrease the leukemic burden, but it is necessary to monitor the impact on hemostatic function. It is recommended to assess the CDSS socre for acute leukemia patients, in order to identify the predictive value for bleedings.

关 键 词：白细胞清除术 高白细胞性白血病 止血功能 中国弥散性血管内凝血诊断积分系统 

分 类 号：R733.7[医药卫生—肿瘤]