[1]朱理平a,朱理佳,王永志a,等.526 例恶性血液病初诊患者血浆凝血等指标检测的临床意义分析[J].现代检验医学杂志,2020,35(01):105-110.[doi:10.3969/j.issn.1671-7414.2020.01.028]
　HU Li-pinga,ZHU Li-jia,WANG Yong-zhia,et al.Clinical Significance Analysis of Detection of Plasma Coagulation and Other Indicators in 526 Patients with Newly Diagnosed Malignant Blood Disease[J].Journal of Modern Laboratory Medicine,2020,35(01):105-110.[doi:10.3969/j.issn.1671-7414.2020.01.028]
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526 例恶性血液病初诊患者血浆凝血等指标检测的临床意义分析()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第35卷
期数:
2020年01期
页码:
105-110
栏目:
论　　著
出版日期:
2020-02-29

文章信息/Info

Title:
Clinical Significance Analysis of Detection of Plasma Coagulation and Other Indicators in 526 Patients with Newly Diagnosed Malignant Blood Disease
文章编号:
1671-7414(2020)01-105-06
作者:
朱理平1a; 朱理佳2; 王永志1a; 潘宝龙1b; 朱士红1b; 孙 竞3
(1.昆明医科大学第六附属医院/玉溪市人民医院a.血液科; b.检验科,云南玉溪 653100; 2.玉溪市儿童医院,云南玉溪 653100; 3.南方医科大学南方医院血液科,广州 510515)
Author(s):
HU Li-ping1a;  ZHU Li-jia2; WANG Yong-zhi1a;  PAN Bao-long1b;  ZHU Shi-hong1b;  SUN Jing3
(1a.Department of Hematology; 1b.Department of ClinicalLaboratory,the Sixth Affiliated Hospital of Kunming Medical UniversityYuxi People’s Hospital,Yunnan Yuxi 653100,China; 2.Yuxi Children’s Hospital, Yunnan Yuxi 653100,China; 3.Department ofHematology, Southern Hospital of Southern Medical University, Guangzhou 510515,China)
关键词:
恶性血液病;  初诊;  凝血指标
分类号:
R737.33
DOI:
10.3969/j.issn.1671-7414.2020.01.028
文献标志码:
A
摘要:
目的 探讨恶性血液病初诊时凝血指标及白细胞、血小板等变化的临床意义。方法 收集2012年1月至2018年8月在玉溪市人民医院确诊恶性血液病患者初诊时PT,FIB,APTT,ATⅢ,FDP,D-D及WBC,PLT等检测资料并整理、分析。结果 526例恶性血液病包括急性白血病(AL)243例,慢性白血病(CL)92例,淋巴瘤34例,多发性骨髓瘤(MM)59例,再生障碍性贫血(AA)37例,骨髓增生异常综合征(MDS)61例。526例中≥1项凝血指标异常者430例,占81.75%。6项凝血指标异常率由高到低依次是D-D 54.00%(236/437),PT 44.30%(233/ 526),FIB 43.35%(228/ 526),FDP 39.93%(119/298),APTT 37.26%(196/ 526),ATⅢ 30.38%(96/316)。各凝血指标组间比较:AL组与CL组FIB,FDP,D-D差异有统计学意义(t=3.89～6.78,均 P<0.01); 白血病组与非白血病组ATⅢ,FDP,D-D差异有统计学意义(t=3.03～3.86,均 P<0.01)。482例血细胞计数WBC 0.12×109/L～792.97×109/L, 377例PLT 2.0×109/L～935.0×109/L。526例中272例伴出血(51.71%),出血发生率: WBC <4.0×109/L者高(占60.90%),PLT ≤30.0×109/L者最高(占96.84%); 白血病组出血发生率高于非白血病组,白血病组以AML-M3型最高(69.77%); 非白血病组中AA最高(70.27%); 出血发生率随凝血指标异常项增多而增高。≥3项异常出血发生率及2级出血发生率,白血病组均高于非白血病组(χ2=5.22,P<0.05; χ2=8.39,P<0.01)。结论 ①恶性血液病初诊时大部分有1项及以上凝血指标异常(81.75%),凝血指标异常以 D-D最敏感。② 出血发生率:WBC,PLT减少者较高,且随PLT减少而增加; 白血病比非白血病高,以M3型最高; 随凝血指标异常项增多而增高。

参考文献/References:

[1] 王书杰.弥散性血管内凝血诊治进展[J].中国实用内科杂志,2017,37(2):91-95. WANG Shujie.Advances in the diagnosis and treatment of disseminated intravascular coagulation[J].Chinese Journal of Practical Internal Medicine,2017,37(2):91-95.
[2] 张之南,沈悌.血液病诊断及疗效标准〔M〕.3版.北京:科学出版社,2007:19-232. ZHANG Zhinan, SHEN Ti.Diagnosis and efficacy standards for blood diseases [M].3thEd. Beijing: Science Press, 2007: 19-232.
[3] 肖芳芳,胡锴勋,郭 梅,等.初诊急性白血病凝血指标异常及其临床意义探讨[J]·中国实验血液学杂志,2013,21(2):300-304. XIAO Fangfang, HU Kaixun, GUO Mei, et al. Abnormality of blood coagulation indexs in patients with denovo acute leukemia and its clinical significance[J].Journal of Experimental Hematology, 2013, 21(2): 300-304.
[4] 王学文.弥散性血管内凝血的诊断与治疗进展[J].医学研究生学报,2003,16(10):783-786.WANG Xuewen.Progress of diagnosis and management disseminated intravascular coagulation[J].Journal of Medical Postgraduates,2003,16(10):783-786.
[5] 王崇宝,胡会社,刘亚民,超声联合靶向微泡治疗急性脑血栓的动物实验研究[J].四川大学学报(医学版),2012,43(6):864-867。WANG Chongbao,HU Huishe,LIU Yamin. Animal study in combining targeted-microbubbles with low-frequency ultrasound for the treatment of ischemic stroke[J].J SichuanUniv(Med Sci Edi),2012,43(6):864 -867.
[6] LEVINE M N,LEE A Y,KAKKAR A K. From trousseau to targeted therapy: new insights and innovations in thrombosis and cancer[J]. J Thromb Haemost,2003,1(7): 1456-1463.
[7] SCHWAMEIS M,SCHOBER A,SCHORGENHOFER C,et al.Asphyxia by drowning induces massive bleeding due to hyperfibrinolytic disseminated intravascular coagulation[J].Crit Care Med,2015,43(11):2394-2402.
[8] 宋丽洁,丁琪,姚桂玲,等.抗凝血酶活性变化的研究及临床意义[J].血栓与止血学,2006,12(4):180-182.SONG Lijie,DING Qi,YAO Guiling,et al.Research status and clinical significance of antithrombin [J].Chinese Journal Thrombotic and Hemostasis,2006,12(4):180-182.
[9] SHITRIT D,IZBICKI G,SHITRIT A B,et al.Normal D-dimer levels in patients with latent tuberculosis infection[J].Blood Coagul Fibrinolysis,2005,16(1):85-87.
[10] 周志刚,许欢,李皎,等.急性白血病合并DIC时联合检测CRP以及D-二聚体的临床价值分析[J].实用临床医学杂志,2016,20(19):159-161.ZHOU Zhigang,XU Huan,LI Jiao, et al.Clinical value of combined detection of CRP and D-dimer in acute leukemia complicated with DIC[J].Journal of Clinical Medicine in Practical,2016,20(19):160.
[11] 吴爱成.D-二聚体对血液病合并弥散性血管内凝血的诊断价值[J].中国热带医学,2016,16(5):505-507.WU Aicheng.Diagnostic value of D-dimer in blood orders combined with disseminated intravascular coagulation[J].China of Tropical Medicine,2016,16(5):505-507.
[12] TAKAHASHI G,SHIBATA S,ISHIKURA H,et al.Presepsin in the prognosis of infectious diseases and diagnosis of infectious disseminated intrazascuiar coagulation:a prospective,multicentre,observational study[J].European Journal of Anaesthesiology(EJA),2015,32(3):199-206.
[13] LEINOE E B,HOFFMANN M H,KJAERSGAARD E,et al.Prediction of haemorrhage in the early stage of acute myeloid leukemia by flow cytometric analysis of platelet function[J].Br J Haematol,2005,128(4):526-532.
[14] MONTESINOS P.SANZ M A. Incidence and prognostic factors for hemorrhagic death in patients with acute myeloid leukemia: a single-centre historical report[J].Thromb Res,2007,20(11):26-37.
[15] 瞿文,门剑龙.急性白血病患者凝血功能变化及意义[J].天津医药,2007,35(5):376-377.Qu Wen, MEN Jianlong. Acute leukemia patients with coagulation function changes and significance [J].Tianjin Medicine, 2007, 35(5): 376-377.
[16] 张之南,郝玉书,赵永强,等.血液病学〔M〕.2版.北京:人民卫生出版社,2015:749,1188.ZHANG Zhinan, HAO Yushu, ZHAO Yongqiang, et al. Hematology [M]. Second Edition. Beijing: People’s Medical Publishing House, 2015: 749, 1188.
[17] 刘仪,王凯,王介非.氧化应激诱导细胞凋亡的机制[J].中华临床感染病杂志,2008,1(3):185-188.LIU Yi, WANG Kai, WANG Jiefei. Mechanism of oxidative stress-induced apoptosis [J].Chinese Journal of Clinical Infectious Diseases, 2008, 1(3): 185-188.
[18] LOPEZ J J,SALIDO G M,GóMEZ-ARTETA E,et al.Thrombin induces apoptotic events through the generation of reactive oxygen species in human platelet[J]. J Thromb Haemost,2007,5(6):1283-1291.
[19] AMOUR A,SLOCEOMBE P M,WEBSTER A,et al.TNF-alpha converting enzyme(TACE)is inhibited by TIMP-3[J].FEBS Lett,1998,435(1):39-44.
[20] GIRISH K S,PAUL M,THUSHARA R M,et al.Melatonin elevates apoptosis in human platelets via ROS mediated mitochondrial damage[J].Biochem Biophys Res Commun,2013,438(1):198-204.
[21] 王振义,李家增,阮长耿,等.血栓与止血基础理论与临床[M].3版.上海:科学技术出版社,2004,671-672.WANG Zhenyi, LI Jiazeng, RUAN Changgen, et al. The basic theory and clinical study of thrombosis and hemostasis [M].3rd Edition, Shanghai: Science and Technology Press, 2004:671-672.

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备注/Memo

备注/Memo:
作者简介:朱理平(1981-)女,医学硕士,主治医师,从事内科血液病诊疗工作,E-mail:1365582462@qq.com。收稿日期:2019-08-08 修稿日期:2019-10-12
更新日期/Last Update: 2020-03-30