急性白血病合并DIC53例临床分析

对５３例ＡＬ合并ＤＩＣ作回顾分析，并发ＤＩＣ的ＡＬ类型为ＡＰＬ２８例，非Ｍ３型ＡＮＬＬ１５例、ＡＬＬ１０例，发生于初发期、诱导化疗和化疗间歇期、难治期的ＤＩＣ分别占２５、１１、１７例。结果显示，ＡＰＬ合并ＤＩＣ６８％发生于初发期、非Ｍ３期ＡＮＬＬ并ＤＩＣ发生于难治期占６０％，而ＡＬＬ并ＤＩＣ５０％与诱导化疗有关。４０例经全程治疗者，ＤＩＣ治愈８例，其中６例为初发期患者（６／１６）。讨论了ＤＩＣ发生     

弥散性血管内凝血患者出凝血分子标志物的检测及其临床价值

目的 探讨弥散性血管内凝血病人出凝血分子标志物的临床应用价值.方法 选择该院2009年7月至2012年9月收治的87例弥散性血管内凝血(DIC)患者,将全部患者按病程分为早期组(n=29)、中期组(n=37)和晚期组(n=21),并随机选择30例同期体检的健康志愿者为对照组,分析常规出凝血指标、出凝血分子标志物检测结果差异,比较三组患者常规出凝血指标、出凝血分子标志物阳性检出率.结果 三组患者与对照组常规出凝血指标检测结果大多有显著性差异,但指标变动规律复杂或无显著性；三组患者与对照组出凝血分子标志物检测结果均有显著性差异,且出凝血分子标志物水平随病程进展呈规律变动.常规出凝血指标平均阳性检出率为59.53％,出凝血分子标志物平均阳性检出率为96.72％,且TAT和D-D三组阳性检出率均达到100％.结论 出凝血标志物在DIC检测中不受凝血因子消耗的影响.血浆含量可随病程进展变动,具有高敏感性和特异性,对于该病的早期诊断与病情监测具有极高的临床价值.     

急性早幼粒细胞白血病合并弥散性血管内凝血（附30例报告）

回顾性分析30例APL并发DIC患者的治疗过程,显示颅内出血为其主要致命性并发症。D-D是高可信度检测指标;APTT易受多种因素影响,如果一项延长,超过正常对照2.5倍以上,高度提示肝素过量。亚临床型DIC应给予小剂量肝素持续静滴;对进展期DIC应同时输注血液制品;确有纤溶亢进时应给予抗纤溶治疗。     

急性白血病患者血浆内皮素水平与DIC的关系

采用放射免疫分析法，测定了49例急性白血病患者（合并DIC21例、无DIC28例）血浆内皮素水平。结果表明，急性白血病合并DIC组血浆内皮素水平明显高于急性白血病无DIC组和正常对照组。急性白血病合并DIC患者血浆内皮素水平随着病情的改善或恶化而升高或降低，血浆内皮素水平越高，死亡率越高。提示，动态测定血浆内皮素水平可以作为估计急性白血病合并DIC预后的指标。     

白血病凝血激活分子标志物的研究

白血病细胞内所含前凝血质（ＰＣＡ）及癌性促凝物（ＣＰ）是致凝血异常的基本原因［１］。我们通过检测白血病患者凝血酶原片段（Ｆ１＋ ２）和凝血酶－抗凝血酶Ⅲ复合物（ＴＡＴ）血浆水平在化疗前后的变化,探讨其凝血异常机制及其临床意义。 一、资料和方法 １．研究对象：正常对照组３０例,男１７例,女１３例,年龄２４～４５岁,平均年龄３７．１岁。无心肝肾疾病,无血栓形成疾病,近期无抗凝药史。患者组白血病３７例（其中Ｍ１３例,Ｍ２４例,Ｍ３５例,Ｍ４２例,Ｍ５３例,Ｍ６１例;Ｌ１１例,Ｌ２８例）;慢性粒细胞白血病…     

急性白血病止凝血异常的预后意义

目的：探讨急性白血病（AL）患者的止凝血异常及其与预后的关系。方法：运用ELISA或发色底物法对56例AL患者血浆一系列止凝血指标进行了检测。结果：治疗前血浆血栓调节蛋白（TM）、P－选择素、可溶性纤维蛋白单体复合物（SFMC）、组织纤溶酶原激活性（t－PA）、D－二聚体水平显著升高,蛋白C抗原（PC：Ag）、纤溶酶原激活抑制物（PAI）水平低于正常,纤维蛋白原（Fg)、蛋白C活性（PC：A）、蛋白S水平（PS）与正常对照组差异无显著性意义,治疗后除蛋白C活性外均恢复至正常范围内;治疗前后TM升高、治疗前PS降低及PAI升高者预后较差,其中治疗后TM和治疗前PAI是决定患者无复归生存时间的预后因素,治疗后TM、治疗前PS和PAI水平是决定患者总生存时间的预后因素。结论：AL发病过程中存在血管内皮细胞损伤、血小板活化以及凝血、抗凝、纤溶系统的激活,并随病情的好转而逐渐改善;血管内皮损伤、PS消耗及纤溶抑制活性增强与患者的预后密切相关。     

止凝血分子标志物变化在老年冠心病合并高血压中的临床意义

目的观察止凝血分子标志物在老年冠心病(CAD)合并高血压(HP)中的变化并探讨其临床意义。方法选择老年CAD患者116例,其中稳定性心绞痛(SAP)患者36例(SAP组),不稳定性心绞痛(UAP)患者38例(UAP组),UAP合并HP 42例;另选健康体检者48例(对照组),分别测定血清血管性血友病因子、抗凝血酶Ⅲ、纤溶酶原、血浆α-颗粒膜蛋白、纤维蛋白原、D-二聚体含量,以及血小板膜糖蛋白分子数,并进行统计学分析。结果老年UPA患者各项指标与正常对照组比较均有统计学意义(P0.05,P0.01),而老年UAP合并HP患者各项指标也明显高于老年单纯UAP患者(P0.05,或P0.01)。结论老年UAP患者存在血栓前状态,其体内存在多种止凝血分子标志物的变化,这种变化在合并HP的老年UAP患者中最突出,可能是导致心肌梗死的重要原因。     

脑出血和脑梗死患者止、凝血分子标志物的检测及意义

应用ELISA法对60例脑梗死患者,30例脑出血患者和对照组50例健康体检查进行血浆TM,ET－1,P－selection,D-Dimer测定,PC活性以发色底物法测定,结果发现,脑梗死组TM,ET－1,P-selection含量显著高于对照组（P＜0．05或P＜0．01）,脑出血组PC活性及D－Dmier含量均显著高于对照组（P＜0．05或P＜0．01）,TM,ET－1含量增高提示脑梗死患者有较严重的血管内皮损伤,P－selection含量增高则提示脑梗死患者血小板被激活,为临床抗血小板聚集及保护血管内皮治疗提供了理论依据,,而高水平的PC和D－Dimer则说明脑出血患者存在抗凝系统及纤溶系统的异常。     

急性早幼粒细胞白血病患者合并弥散性血管内凝血的影响因素及列线图模型构建

目的:探讨急性早幼粒细胞白血病(APL)合并弥散性血管内凝血(DIC)的影响因素,建立初诊APL患者发生DIC风险的预测模型,为临床诊治提供参考。方法:回顾性分析单中心179例初诊APL患者的临床资料,根据有无DIC进行分组,采用单因素及多因素回归分析,探讨APL合并DIC的影响因素,构建列线图预测模型,采用校正曲线、受试者工作特征曲线下的面积(AUC)及一致性指数(CI)评价模型的预测价值。结果:179例初诊APL患者平均年龄41.77岁,根据临床和实验室指标分为DIC组(95例,53.07%),非DIC组(84例,46.93%)。单因素分析显示：预后分层、骨髓早幼粒细胞比例、初诊时白细胞计数、中性粒细胞绝对值、凝血酶原时间、凝血酶时间、纤维蛋白原(FIB)、纤维蛋白降解产物(FDP)、D-二聚体、乳酸脱氢酶(LDH)水平在2组中比较,差异有统计学意义(均P<0.05)。多因素分析显示,初诊时FIB、FDP及LDH水平为APL合并DIC的独立影响因素(OR=0.418、1.009、1.005,P<0.05)。列线图模型预测APL合并DIC的AUC为0.845,CI为0.8...     

急性白血病并发弥散性血管内凝血15例临床分析

出血是急性白血病主要表现之一,引起出血的原因有多种,尤其并发弥散性血管内凝血(DIC)的后果严重,现对我院1988年以来15例临床资料进行分析总结,以提高对该症的诊治水平。     

Coincidence of acquired factor-X deficiency and disseminated intravascular coagulation in patients with acute nonlymphoblastic leukemia

Summary Systematic clotting studies were performed in 157 patients with de novo acute nonlymphoblastic leukemia (ANLL) prior to treatment. Sixteen patients had disseminated intravascular coagulation (DIC). Three of the patients with DIC (two with M3, one with M5 leukemia) had a marked isolated factor-X deficiency (factor XC 21%, 33%, and 41%, respectively). Another four patients had a mild isolated factor-X deficiency (factor XC 55%–68%). In these seven patients the remaining liver-synthesized clotting factors (factors II, VII, IX, V) as well as serum albumin and cholinesterase were within the normal range. Liver disease or vitamin-K deficiency could therefore be excluded. In none of the 141 patients without DIC was a marked isolated factor X deficiency observed; two patients had moderately reduced factor XC levels but normal liver-synthesized proteins. Induction treatment led to the control of DIC with an almost parallel increase of fibrinogen and factor X up to normal in all patients with factor-X deficiency who achieved complete remission. In one patient, recurrence of leukemia was associated with reoccurrence of DIC and marked factor-X deficiency. We conclude that there is a coincidence of isolated factor-X deficiency and DIC in some patients with ANLL. In some patients, this factor-X deficiency may be severe enough to contribute to the bleeding tendency.     

成分输血在产科急性弥漫性血管内凝血治疗中的应用

目的：探讨成分输血在产科急性弥漫性血管内凝血（DIC）中的作用。方法：将35例产科DIC患者分为2组,输成分血组、输全血组。对治疗前后进行血液学指标检验,对检验结果进行比较。结果：成分输血组和输全血组患者治疗后血液学检查HGB、HCT、PLT、PT、APTT、D-D等9项指标与输血前比较差异有统计学意义（P〈0．01）,成分输血组的PT、TT、D-D指标结果改变优于输全血组（P〈0．05,P〈0．01）。结论：成分输血在治疗产科DIC的患者较输注全血安全有效。     

Thrombomodulin in the management of acute cholangitis-induced disseminated intravascular coagulation

AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-induced DIC and who were treated at our hospital were enrolled in this study. The diagnoses of AC and DIC were made based on the 2013 Tokyo Guidelines and the DIC diagnostic criteria as defined by the Japanese Association for Acute Medicine, respectively. Thirty consecutive patients who were treated with r TM between April 2010 and September 2013(r TM group) were compared to 36 patients who were treated without r TM(before the introduction of r TM therapy at our hospital) between January 2005 and January 2010(control group). The two groups were compared in terms of patient characteristics at the time of DIC diagnosis(including age, sex, primary disease, severity of cholangitis, DIC score, biliary drainage, and anti-DIC drugs), the DIC resolution rate, DIC score, the systemic inflammatory response syndrome(SIRS) score, hematological values, and outcomes. Using logistic regression analysis based on multivariate analyses, we also examined factors that contributed to persistent DIC. RESULTS: There were no differences between the r TM group and the control group in terms of the patients' backgrounds other than administration. DIC resolution rates on day 9 were higher in the r TM group than in the control group(83.3% vs 52.8%, P 0.01). The mean DIC scores on day 7 were lower in the r TM group than in the control group(2.1 ± 2.1 vs 3.5 ± 2.3, P = 0.02). The mean SIRS scores on day 3 were significantly lower in the r TM group than in the control group(1.1 ± 1.1 vs 1.8 ± 1.1, P = 0.03). Mortality on day 28 was 13.3% in the r TM group and 27.8% in the control group; these rates were not significantly different(P = 0.26). Multivariate analysis identified only the absence of biliary drainage as significantly associated with persistent DIC(P 0.01, OR = 12, 95%CI: 2.3-60). Although the difference did not reach statistical significance, primary diseases(malignancies)(P = 0.055, OR = 3.9, 95%CI: 0.97-16) and the non-use of r TM had a tendency to be associated with persistent DIC(P = 0.08, OR = 4.3, 95%CI: 0.84-22).CONCLUSION: The add-on effects of r TM are anticipated in the treatment of AC-induced DIC, although biliary drainage for AC remains crucial.     

Acute renal failure and disseminated intravascular coagulation following diabetic ketoacidosis

Summary A patient with acute renal failure and disseminated intravascular coagulation following diabetic ketoacidosis is described. The etiology of acute renal failure in diabetic ketoacidosis is discussed.     

Disseminated intravascular coagulation in acute lymphoblastic leukemia at presentation and in early phase of remission induction therapy

 A high frequency of disseminated intravascular coagulation (DIC) in adult acute lymphoblastic leukemia (ALL) has been reported; however, its clinical relevance and characteristics have not been fully determined. We studied 67 adults with newly diagnosed ALL between 1982 and 1996 to clarify these questions. DIC was diagnosed in ten of 64 patients (16%) who underwent coagulation study at presentation and in 14 of 40 patients (35%) screened for DIC within 7 days after starting remission induction therapy. Overall, 24 of 67 patients (36%) had DIC during this period. Hemorrhagic symptoms were generally mild, while two patients required red blood cell transfusions. Patients who developed DIC had higher white blood cell counts and more frequently a palpable spleen than those who did not. There was no difference in age, French-American-British subtype, karyotype, immunophenotype, lactate dehydrogenase level, percentage of blasts in bone marrow, or frequency of lymphadenopathy or hepatomegaly between patients who had DIC and those who did not. Fibrinolysis tended to be milder in DIC complicating ALL than in that complicating acute promyelocytic leukemia; however, there was no difference in other coagulation parameters between these two subtypes. An etiological link between CD34 expression in common ALL patients and DIC was suggested. Received: December 8, 1997 / Accepted: March 13, 1998     

All-trans retinoic acid in acute promyelocytic leukemia: Preliminary results in Cuba

Summary Seven patients with acute promyelocytic leukemia (APL) were treated with all-trans retinoic acid (ATRA). Five (71.4%) achieved complete remission (CR). Most side effects were transient and well tolerated. Hyperleukocytosis was the major adverse effect. These observations confirm the efficacy of ATRA for inducing CR in APL.     

Tissue factor procoagulant activity of plasma microparticles in patients with cancer-associated disseminated intravascular coagulation

Tissue factor (TF) expressed on sub-cellular membrane vesicles, so-called plasma microparticles (MPs), has recently emerged as a potential key player in intravascular coagulation activation in various disease states. In this report, we demonstrate significantly increased levels of TF-specific procoagulant activity (PCA) of plasma MPs in five patients presenting with overt disseminated intravascular coagulation (DIC) due to an underlying malignancy, including non-small-cell lung cancer (n = 1), melanoma (n = 1), prostate cancer (n = 2), and acute promyelocytic leukemia (n = 1). Clotting experiments on available tumor cell samples suggested that cancer cells were a potential source of circulating TF-positive MPs at least in three of the five patients. Furthermore, follow-up plasma samples from two surviving patients revealed that response of their malignancies to specific anti-cancer therapy was paralleled by resolution of overt DIC and a significant decline in MP-associated TF PCA. Levels of plasma TF antigen, as assessed by an enzyme-linked immunosorbent assay, were also increased at presentation albeit to a lesser extent compared to MP-associated TF PCA, likely due to insufficient solubilization of the phospholipid-incorporated full-length TF molecule by the detergent. In summary, our findings suggest that MP-associated TF PCA may play an important pathogenic role in the evolution of overt DIC in various types of malignancy.     

Disseminated intravascular coagulation in liver cirrhosis

We measured thrombin-antithrombin III complex (TAT), soluble fibrin (SF) and D-dimer levels in 51 patients with liver cirrhosis to determine whether these tests provide new evidence for the presence of disseminated intravascular coagulation (DIC) in liver cirrhosis. TAT levels (median, range) were increased in the patient group (4.2 micrograms/l, 1.8-60.0) compared to the reference group (2.0 micrograms/l, range 1.5-7.6 micrograms/l). SF levels (0 nmol/l, range 0-80 nmol/l) were also increased in the patients as compared to the controls (0 nmol/l, 0), but there was no correlation between TAT and SF levels (r = 0.23, p less than 0.98). TAT levels did not correlate with AT-III levels (r = -0.36, p less than 0.49), but there was an inverse correlation between SF and AT-III (r = 0.60, p less than 0.001). If AT-III levels were above 0.30 U/ml, SF levels remained low, whereas SF levels were increased in patients with AT-III levels below 0.30 U/ml. These findings suggest that if sufficient AT-III is present, thrombin formation is adequately controlled, whereas at low levels of AT-III, thrombin escapes inactivation by AT-III and may act upon fibrinogen, leading to the formation of SF and a low-grade DIC. SF levels correlated well with D-dimer levels (r = 0.55, p less than 0.001), which is consistent with DIC and secondary fibrinolysis. In conclusion: (1) thrombin formation is increased in liver cirrhosis, as indicated by increased TAT levels in 21 of 51 patients; (2) the plasma concentration of AT-III appears to be of major importance for the development of DIC. The present study provides evidence for DIC in severe liver cirrhosis when AT-III levels are less than 0.30 U/ml.     

Adrenal cortical carcinoma initially presented with overwhelming disseminated intravascular coagulation

We report a 54-year-old man who had adrenal cortical carcinoma initially manifested as features of overwhelming disseminated intravascular coagulation (DIC). In the initial diagnostic work-up, an adrenal mass was detected with venous thrombi in the abdominal imaging study, but the radiologic diagnosis was a hematoma arising from the adrenal gland and a biopsy was not possible due to a bleeding tendency. A lot of platelets and plasma products were transfused, but the bleeding tendency and other DIC features persisted. Finally, he expired because of newly developed massive pulmonary thromboembolism. To our knowledge, this is the first reported case of adrenal cortical carcinoma complicated with bleeding tendency caused by DIC as an initial manifestation. This suggests that adrenal cortical carcinoma should be considered in a patient with an adrenal mass and DIC features.