早幼粒细胞白血病合并DIC患者的诱导缓解期凝血指标观察

摘要

目的：探讨凝血检查在判断早幼粒细胞白血病合并DIC患者中的临床意义。方法合并DIC的早幼粒细胞白血病患者用维甲酸或合并亚砷酸诱导缓解治疗，动态测定凝血酶原时间（ PT）、激活部分凝血活酶时间（ aPTT）、凝血酶时间（TT）、血浆纤维蛋白原（Fbg）、抗凝血酶（AT）、D二聚体（D-D）和纤维蛋白降解产物（FDP）。结果17例患者中，15例合并DIC。其中15例患者均在35天内获得完全缓解。 PT、Fbg、D-D和FDP均明显异常，与临床出血症状、DIC相关；aPTT、TT和AT均在正常范围内波动。结论动态观察血浆Fbg、D-D和FDP有助于判断DIC存在与严重程度，Fbg水平对指导血制品输注更有意义。%Objective To explore clinical significance of coagulation parameter in acute promyelocytic leukemia complicated with DIC .Methods 17 cases with acute promyelocytic leukemia were treated with all-trans retinoic acid solely or plus arsenic trioxide .Dynamic detection of coagulation profiles were conducted . Results 17 cases were diagnosis as de novo acute promyelocytic leukemia , and 15 cases were complicated with DIC.A total of 15 cases achieved complete remission within 35 days.Dynamic observation showed that prothrombin time ,serum fibrinogen , D-dimer and fibrin degradation product were significantly out of normal value at interval of induction treatment .These parameters were associated with clinical hemorrhage and DIC manifestations .Serum fibrinogen level was more helpful in guiding transfusion of blood products .Activated partial thromboplastin time ,thrombin time , and antithrombin were fluctuated at normal range .Conclusion Dynamic observation on fibrinogen ,D-dimer and fibrin degradation product may contribute to DIC diagnosis and severity evaluation .Serum fibrinogen can be used as an indicator for guiding transfusion of blood products .