不同抗凝药物治疗急性早幼粒细胞白血病伴播散性血管内凝血

目的研究不同抗凝药物治疗急性早幼粒细胞白血病(APL)伴播散性血管内凝血(DIC)的疗效及患者凝血指标的变化。方法选择我院从2010年2月至2015年1月收治的92例APL伴DIC患者为研究对象。随机分为两组,每组46例。两组均进行实验室指标与体征检查,进行常规APL治疗,分别给予小剂量低相对分子质量肝素(LMWH)与诺保思泰抗凝治疗。分别于治疗前、治疗后一周测两组血浆凝血酶原时间(PT)、部分凝血酶原时间(a PTT)、纤维蛋白原(Fbg)及D二聚体(D-D)含量,于治疗后7 d对两组进行疗效评估,治疗后1个月内记录两组胃肠道不适、肺损伤、心功能损伤情况发生率,并统计两组复发和死亡情况。结果与治疗前相比,两组治疗7 d后血浆PT、a PTT、Fbg及D-D均有明显下降(P0.05),但LMWH组下降程度较诺保思泰组更显著(P0.05);治疗1周后,LMWH组治疗有效率可达80.43%,与对照组60.87%相比明显升高(P0.05);治疗后1个月内两组胃肠道不适、肺损伤及心功能损伤发生率无明显差异(P0.05);两组治疗后1个月内均无复发,死亡率也相当(P0.05)。结论采用小剂量LMWH治疗APL伴DIC,可获得优于诺保思泰的临床疗效,并显著改善患者凝血指标。

Patients with Acute Promyelocytic Leukemia Complicated Disseminated Intravascular Coagulation Treated by Different Anticoagulant Drugs

Objective To study the curative effects and changes of blood coagulation indexes in patients with acute promyelocytic leukemia (APL) complicated disseminated intravascular coagulation (DIC) treated by different anticoagulant drugs.Methods 92 cases of patients with APL complicated with DIC who were treated in our hospital between February 2010 and January 2015 were selected as the study objects and were randomized into two groups,46 cases in each group.Laboratory indexes and physical examinations were performed in both of the two groups.All patients underwent routine treatment for APL.The two groups were given low-dose low molecular weight heparin (LMWH)and Argatroban Injection anticoagulant therapy,respectively.The plasma prothrombin time (PT),activated partial prothrombin time (aPTT),contents of fibrinogen(Fbg) and D-dimer(D-D) in the two groups were determined by automatic whole blood instrument before treatment and one week after treatment.7 days after treatment,the curative effects in the two groups were evaluated.1 month after treatment,the incidence rates of gastrointestinal discomfort,lung injury and cardiac function injury in the two groups were recorded,and the status of recurrence and death was statistically analyzed.Results After 7 days of treatment,plasma PT,aPTT,Fbg and D-D in the two groups were significantly lower than those before treatment (P ＜ 0.05).However,the decrease in low molecular heparin group was more obvious than that in Argatroban Injection group (P ＜ 0.05);After 1 week of treatment,the effective rate in low molecular heparin group (80.43 ％)was significantly higher than that in the control group (60.87％) (P ＜ 0.05);There were no significant differences in the incidence rates of gastrointestinal discomfort,lung injury and cardiac function injury between the two groups in 1 month after treatment (P ＞ 0.05);There was no recurrence in the two groups in month after treatment,and the mortality rates were similar (P ＞ 0.05).Conclusion The application of low-dose low molecular heparin in the treatment of APL with DIC can obtain better effects than Argatroban Injection and significantly improve the coagulation indexes.