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目的探讨急性白血病（ＡＬ）患者蛋白Ｃ（ＰＣ）系统的改变及其与分型、出血情况和预后的关系。方法运用ＥＬＩＳＡ或发色底物法对９３例ＡＬ患者血浆ＰＣ活性和抗原（ＰＣ：Ａ和ＰＣ：Ａｇ）、血栓调节蛋白（ＴＭ）及蛋白Ｓ（ＰＳ）水平进行了检测。结果治疗前血浆ＴＭ水平显著升高，ＰＣ：Ａｇ水平低于正常，ＰＣ：Ａ和ＰＳ水平与正常对照组无显著差异；缓解后除ＰＣ：Ａ和急性淋巴细胞白血病患者ＰＣ：Ａｇ增高外余均恢复至正常范围内。上述指标与出血程度无关。全反式维甲酸治疗组ＰＣ：Ａ和ＴＭ有所升高，在三氧化二砷治疗组未发现上述现象。治疗前后ＴＭ升高，治疗前ＰＳ降低者预后较差，其中治疗前ＰＳ和治疗后ＴＭ是决定患者无复发生存时间独立的预后因素，治疗后ＴＭ是决定患者总生存时间独立的预后因素。结论ＡＬ发病过程中存在ＰＣ系统的激活，并随病情的好转而基本改善。ＰＣ系统并非是决定出血程度的关键因素，但ＴＭ升高及ＰＳ消耗与患者的预后密切相关。
Objective To investigate the changes of protein C (PC) system in patients with acute leukemia (AL) and its relationship with type, hemorrhage and prognosis. Methods Plasma PC activity, antigens (PC: A and PC: Ag), thrombomodulin (TM) and protein S (PS) levels were detected in 93 AL patients by ELISA or chromogenic substrate method. Results Plasma TM levels were significantly increased before treatment, PC:Ag levels were lower than normal, and PC:A and PS levels were not significantly different from those in the normal control group; PC:A and PCL in patients with acute lymphoblastic leukemia increased after remission. Both returned to normal range. The above indicators have nothing to do with the degree of bleeding. PC:A and TM were elevated in the all-trans retinoic acid treatment group, but not in the arsenic trioxide treatment group. The increase in TM before and after treatment, the poor prognosis of patients with poor PS before treatment, which before treatment and after treatment of TM is an independent prognostic factor in patients with relapse-free survival time, TM after treatment is an independent prognostic factor to determine the overall survival time. Conclusion There is activation of PC system in the pathogenesis of AL, and it basically improves with the improvement of the disease. PC system is not a key factor in determining the degree of bleeding, but elevated TM and PS consumption are closely related to the prognosis of the patient.