首都医科大学学报 ›› 2005, Vol. 26 ›› Issue (5): 573-576.

• 儿科学研究 • 上一篇    下一篇

左旋门冬酰胺酶导致急性淋巴细胞白血病患儿出凝血异常的探讨

吴润晖, 段渊, 周儇, 马晓莉, 吴敏媛   

  1. 首都医科大学附属北京儿童医院血液病中心
  • 收稿日期:2005-08-20 修回日期:1900-01-01 出版日期:2005-10-24 发布日期:2005-10-24

Effect of L-asparaginase on Coagulation Abnormatities in Children with Acute Lymphoblastic Leukemia

Wu Runhui, Duan Yuan, Zhou Xuan, Ma Xiaoli, Wu Minyuan   

  1. Hematology Center, Beijing Children's Hospital, Capital University of Medical Sciences
  • Received:2005-08-20 Revised:1900-01-01 Online:2005-10-24 Published:2005-10-24

摘要:

目的 分析急性淋巴细胞白血病(ALL)患儿应用左旋门冬酰胺酶(L-asp)所致的出凝血改变、相关原因及对策。方法 前瞻性收集北京儿童医院血液病中心应用L-asp的ALL患儿51例,1)分析应用L-asp前、中、后出凝血指标:部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)和抗凝血酶(AT)变化,并比较不同化疗强度(高、标危方案)和不同化疗阶段(第1、2、3次应用)出凝血指标变化;2)分析出凝血变化与血小板、D-二聚体和肝损害的相关性;3)探讨预防性输注新鲜冰冻血浆或纤维蛋白原的意义。结果 51例患儿中,1)应用L-asp中、后期,Fib和AT值显著降低,但不同化疗强度和不同化疗阶段对L-asp中、后出凝血指标变化无明显影响。2)应用L-asp中、后期,血小板、D-二聚体、谷丙转氨酶(GPT)、谷草转氨酶(GOT)和肝脂肪变性与应用前相比无显著性改变。3)进行预防性补充输注的病人无血栓、出血并发症发生。结论 ALL患儿应用L-asp后Fib和AT显著下降;其改变与化疗强度、化疗阶段、凝血因子消耗及肝功能损伤无明显相关;预防性补充输注可能会减少血栓/出血并发症。

关键词: 急性淋巴细胞白血病, 儿童, 左旋门冬酰胺酶, 出凝血

Abstract:

Objective To analyze the alterations and the causes of coagulation in children with acute lymphoblastic leukemia (ALL) during L-asparaginase(L-asp) treatment and to find out the solutions.Methods 51 ALL patients were analyzedprospectively with 1) changes of APTT,PT,Fib and AT before,during and after treatment of L-asp;comparing the changes different protocols and in different periods of chemotherapy;2) the relationship between coagulation and changes of platelet and(D-dimer) as well as liver function.3) the significance of supplementary therapy in patients with lower AT and/or Fib.Results (1) Fib) and AT were significantly decreased during and at the end of L-asp treatment,but not influenced much by intensity and stages of chemotherapy.2) There were no significant changes of platelets,(D-dimer) and liver function during and at the end of(L-asp).(3) No) thrombosis or hemorrhage occurring after prophylactic supplementary transfusion of AT and/or Fib.Conclusion The negative alterations of Fib and AT were significant in ALL patients during L-asp therapy;These changes were not influenced much by intensity or stages of chemotherapy,neither by liver function;The prophylactic supplementary therapy may reduce the complications of thrombosis and hemorrhage during L-asp treatment.

Key words: acute lymphoblastic leukemia, children, L-asparaginase(L-asp), coagulation

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