初诊急性白血病患者化疗前后血浆可溶性血管内皮细胞蛋白C受体、血管性血友病因子、P-选择素水平的变化

目的探讨初诊急性白血病(AL)患者化疗前后血浆可溶性血管内皮细胞蛋白C受体(s EPCR)、血管性血友病因子(v WF)、P-选择素(P-selectin)含量变化的临床价值。方法选取105例初诊AL患者以及120例健康体检者作为研究对象,再根据疾病类型将入组的初诊AL患者分为急性淋巴细胞白血病(ALL,35例)、急性早幼粒细胞白血病(APL,37例)、不包括APL的急性粒细胞白血病(non-APL AML,33例)。ALL组患者采用VDLP方案诱导化疗,APL组患者采用全反式维甲酸、三氧化二砷、柔红霉素方案诱导化疗,non-APL AML组患者采用DA方案或IA方案诱导化疗。采用酶联免疫吸附试验(ELISA)检测初诊AL患者化疗前后以及健康体检者的血浆s EPCR、v WF、P-selectin水平。结果 1初诊AL患者化疗前血浆s EPCR、v WF、P-selectin水平显著高于健康体检组(P0.05)。初诊AL患者化疗完全缓解后血浆s EPCR、v WF、P-selectin水平显著低于化疗前(P0.05),但是血浆s EPCR、v WF水平仍然显著高于健康体检组(P0.05),而血浆P-selectin水平与健康体检组相比差异无显著性(P0.05)。2不同类型初诊AL患者化疗前血浆s EPCR、v WF、P-selectin水平相比差异有显著性(P0.05),APL患者血浆s EPCR、v WF、P-selectin水平显著高于ALL患者、non-APL AML患者(P0.05),ALL患者与non-APL AML患者之间血浆s EPCR、v WF、P-selectin水平相比差异无显著性(P0.05)。结论初诊AL患者在治疗前往往伴随有血管内皮细胞损伤、血小板活化以及血液高凝状态,这种情况以APL表现更为显著。

Changes of Plasma Soluble Vascular Endothelial cell Protein C Receptor;von Willebrand factor/P-selectin Levels in Patients with Newly Diagnosed Acute Leukemia Before and After Chemotherapy

Objective To investigate acute leukemia(AL) before and after chemotherapy in patients with plasma soluble vascular endothelial cell protein C receptor (sEPCR),vascular yon Willebrand factor (VWF),P-selection element (P-selectin) content of clinical value.33 cases in Methods Selected 105 cases of newly diagnosed al patients and 120 healthy persons as the research object,again according to the type of disease in group of newly diagnosed al patients divided into acute lymphoblastic leukemia,35 cases),acute promyelocytic myeloid leukemia (APL,37 cases),excluding APL of acute myeloid leukemia (AML non-APL.Patients in group ALL were treated with VDLP chemotherapy.Patients in group APL were treated with all trans retinoic acid,arsenic trioxide and erythromycin.The patients in group AML were treated with DA regimen or IA regimen.Plasma levels of sEPCR,vWF and P-selectin were detected by enzyme linked immunosorbent assay(ELISA) before and after chemotherapy in patients with newly diagnosed AL.Results The plasma levels of sEPCR,vWF and P-selectin were significantly higher in the patients with newly diagnosed AL before chemotherapy(P ＜0.05).After complete remission in patients with newly diagnosed Al plasma sEPCR,vWF and P-selectin levels were significantly lower than those before chemotherapy(P ＜0.05),but plasma sEPCR and vWF levels is still significantly higher than healthy group (P ＜ 0.05),and plasma P-selectin level and the healthy control group compared no significant (P ＞ 0.05).There was a significant difference (P ＜ 0.05) compared with 2 different types of patients with newly diagnosed al patients before chemotherapy plasma sEPCR,vWF and P-selectin levels,APL patients plasma sEPCR,vWF and P-selectin level was significantly higher than that in patients with acute lymphoblastic leukemia(all),non-APL AML patients (P ＜ 0.05),with acute lymphoblastic leukemia (all) and non-APL AML patients plasma sEPCR,vWF and P-selectin levels compared no significant (P ＞ 0.05).Conclusion In patients with AL before treatment,there is often accompanied by vascular endothelial cell injury,platelet activation and blood coagulation state,which is more significant in APL.