儿童急性白血病患者血浆止凝血分子标志物检测的临床意义

目的　了解三种止凝血分子标志物在不同类型 ,不同出血程度的儿童急性白血病 (AL)患者中的变化并探讨其临床意义。方法　用ElISA方法检测了 56例初诊AL患儿血浆中的凝血酶调节蛋白 (TM) ,可溶性纤维蛋白单体复合物 (SFMC) ,D-二聚体 (D -D)含量 ,并用常规方法检测了 56例AL患儿的血小板 (BPC)、血浆凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT)、凝血酶时间 (TT)、鱼精蛋白副凝试验( 3P)及纤维蛋白原定量 (Fg)。结果　 56例AL患儿的SFMC、D -D均值高于正常对照组儿童的均值 ,两组比较有显著差异 (P <0 0 5)。急性非淋巴细胞白血病 (ANLL)与急性淋巴细胞白血病 (ALL)比较 ,ANLL患儿组的SFMC、D -D的血浆含量显著高于ALL组。高白细胞性急性白血病 (HLAL)与其它初诊时白细胞数低于 1 0 0× 1 0 9/L的AL患儿比较 ,TM、SFMC、D -D均有显著差异 (P <0 0 5)。无出血组与正常对照比较 ,SFMC、D -D及BPC有显著差异 (P <0 0 5) ,其它项目无显著差异 ,轻度出血组与无出血组比较 ,BPC减低有显著差异 (P <0 0 5) ,而其它项目无显著差异 ,重度出血组与轻度出血组相比较 ,TM、SFMC、D -D、3P试验、Fg均有显著差异。结论　 1、儿童AL患儿存在不同程度凝血、纤溶紊乱 ,以HLAL患儿最严重。 2、血管内皮细胞受损 ,?

Clinical significance of examining the plasma levels of hemostatic molecular markers in children with acute leukemia

Objective To know the changes of three hemostatic molecular markers in children with different acute leukemia (AL) and bleeding manifestation for elucidating their clinical significance. Methods Thrombomodulin (TM)?soluble fibrinomonomer complex (SFMC)? D-dimer (D-D) were examined at diagnosis in 56 children with AL using ELISA. Platelet count (BPC)?activated partial thromboplastin time (APTT)?fibrinogen (Fg)? prothrombin time (PT) thrombin time (TT)?plasma protamine pracoagulation test (3P test) were examined using routine methods. Result Compare with control group, the plasma levels of SFMC, and D-D were elevated significantly in 56 children with AL. The plasma levels of SFMC and D-D in ANLL group were much higher than those in ALL group. The plasma level of TM, SFMC and D-D in HLAL group were much higher than those in children with AL at diagnosis leukocyte count below 100×10 9/L. There were difference significant in level of SFMC?D-D and BPC between no bleeding group and the control group. Compare with no bleeding group there were significant difference in BPC in mild bleeding group, but no difference in other exminined test. There were significant difference in the plasma levels of TM?SFMC?D-D?Fg. between mild bleeding group and severe bleeding group. Conclusion ①There existed coagulation and fibrinolysis disorder in children with AL, especial children with HLAL. ②Severe bleeding in children with AL occurs as result of the injury of vascular endotheliun? the activation of coagulant and fibrinolytic system. ③The examining SFMC?D-D?was more susceptible than routine methods for detecting disorder of coagulant and fibrinolytic in children with AL.