| 张迎媚,陈 波,吴龙月,赵红丽,李海涛.急性早幼粒细胞白血病合并弥散性血管内凝血亚砷酸诱导治疗疗效分析[J].,2018,(8):1498-1501 |
| 急性早幼粒细胞白血病合并弥散性血管内凝血亚砷酸诱导治疗疗效分析 |
| Efficacy of Arsenic Trioxide for the Treatment of Acute Promyelocytic Leukemia Combined with Disseminated Intravascular Coagulation |
| 投稿时间：2017-06-23 修订日期：2017-07-18 |
| DOI：10.13241/j.cnki.pmb.2018.08.019 |
| 中文关键词: 急性早幼粒细胞白血病 弥散性血管内凝血 亚砷酸 疗效 |
| 英文关键词: Acute promyelocytic leukemia Disseminated intravascular coagulation Arsenic trioxide Curative effect |
| 基金项目:黑龙江省教育厅科学技术研究项目(12541345) |
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| 中文摘要: |
| 摘要 目的：探索急性早幼粒细胞白血病（APL）合并弥散性血管内凝血（DIC）患者亚砷酸（ATO）诱导治疗的疗效及治疗过程中凝血相关临床特征及实验室指标的变化情况。方法：前瞻性收集我院血液内科2014年7月-2016年12月期间收治的初诊和复发APL合并DIC患者24例，于给予ATO诱导治疗前（第0周）及治疗第1、2、3周，血液学完全缓解（HCR）时完善相关检查。每例患者设立正常对照1名。结果：24名患者中初发21例，复发3例，所有患者均有出血症状。最常见出血为皮肤粘膜出血。经过ATO诱导治疗后，21例患者（87.5%）达HCR，2例患者死于脑出血，1例患者达部分缓解。患者第0周（治疗前）凝血酶原时间（PT）显著延长， D-二聚体（DD），纤维蛋白原（FIB）显著降低，纤维蛋白原降解产物（FDP）明显增高（P <0.001），ATO治疗1周时出血症状、PT、FIB基本纠正，DD、FDP改善明显，但DD、FDP直到HCR时仍高于正常。结论：ATO单药治疗APL合并DIC的HCR率高，并能在1周内迅速减轻凝血紊乱，但患者达HCR时凝血紊乱仍不能完全纠正。PT、FIB、DD、FDP可作为判断ATO治疗APL合并DIC疗效的重要参数。 |
| 英文摘要: |
| ABSTRACT Objective: The study to explore the efficacy of induction therapy with arsenic trioxide (ATO) for acute promyelocytic leukemia (APL) combined with disseminated intravascular coagulation (DIC). The clinical features related with coagulation and the changes of laboratory data during the course of treatment also were analyzed. Methods: Twenty-four patients (21 de novo, 3 relapsed) who were diagnosed as acute promyelocytic leukemia and admitted to our hospital from July 2014 to December 2016 were studied and analyzed. Every laboratory examination was measured for all patients before (0 week) and 1, 2, 3weeks and after ATO treatment until hematologic complete remission (HCR). The control group consisted of 24 sex and age matched healthy individuals. Results: Hemorrhages were observed in the 24 patients, mucocutaneous hemorrhage is commonly encountered. After the induction therapy by ATO, 21 patients (87.5%) achieved HCR, 2 patients died of cerebral hemorrhage, and 1 patient achieved partial remission. Prothrombin time (PT) was significantly prolonged, D-dimer (DD) and fibrinogen (FIB) were outstanding decreased and fibrin (-ogen) degradation products(FDP) was significantly increased (P <0.001) before treatment (0 week), and 1 week after treatment, and the clinical symptoms of hemorrhage were improve markedly, PT and FIB were returned to normal, DD and FDP were improved obviously, while DD and FDP were still higher than normal until HCR. Conclusion: The HCR rate of APL combined with DIC which treated with the single-agent ATO regimen is high. Besides, coagulation disorders can be relieved quickly during the first week, but the conglomeration parameter can’t be completely corrected when HCR. PT, FIB, DD and FDP can be used as key parameters to judge the efficacy of ATO in the treatment of APL combined with DIC. |
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