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目的 :观察急性单核白血病 (AML- M5 )止凝血因子标志物的变化 ,探索 AML- M5 患者出血机制及这些标志物在疾病诊疗、预后判断中的意义。方法 :用酶联免疫吸附法对 17例 AML- M5 患者进行一系列止凝血因子标志物动态检测 ,包括组织因子 (TF)、组织因子途径抑制物 (TFPI)、凝血酶 -抗凝血酶复合物 (TAT)、纤溶酶 -抗纤溶酶复合物 (PAP)、尿激酶型纤溶酶原激活物 (u- PA)、尿激酶型纤溶酶原激活物受体 (u- PAR) ;同时还对患者骨髓分离单个核细胞的促凝活性 (PCA)进行测定 ,并将这些指标检测结果与正常对照组进行比较。结果 :治疗前 ,AML - M5 组 TF、TFPI、TAT、PAP、u- PA、u- PAR较正常对照组均显著升高 (P <0 .0 5 ) ;治疗后 ,TFPI、PAP恢复正常 ,而 TF、TAT仍维持高水平 ;u- PA、u- PAR在未缓解者中持续增高 ,而在缓解者中恢复正常。结论 :AML- M5 患者体内同时存在凝血、抗凝、纤溶功能异常 ,表现为组织因子表达增高、凝血酶生成增加、纤溶酶原激活物大量释放、纤溶亢进 ,并伴随病情好转而逐渐改善 ,但治疗后患者仍处于高凝状态。u- PA、u- PAR可作为判断预后的一种指标。
Objective: To observe the changes of markers of acute mononuclear leukemia (AML-M5) clotting factors, explore the mechanism of hemorrhage in AML-M5 patients and the significance of these markers in disease diagnosis, prognosis and prognosis. METHODS: A series of anticoagulant markers were detected in 17 patients with AML-M5 by enzyme-linked immunosorbent assay, including tissue factor (TF), tissue factor pathway inhibitor (TFPI), and thrombin-antithrombin complex. (TAT), plasmin-antiplasmin complex (PAP), urokinase-type plasminogen activator (u-PA), urokinase-type plasminogen activator receptor (u-PAR) At the same time, the procoagulant activity (PCA) of bone marrow isolated mononuclear cells was also measured, and the results of these indicators were compared with the normal control group. Results: Before treatment, TF, TFPI, TAT, PAP, u-PA, uPAR in AML-M5 group were significantly higher than those in normal control group (P < 0.05). After treatment, TFPI and PAP returned to normal. However, TF and TAT remained high; u-PA and u-PAR continued to increase in patients who did not respond, but returned to normal in responders. CONCLUSIONS: Coagulation, anticoagulation, and fibrinolytic dysfunction are present in AML-M5 patients, manifested by increased expression of tissue factor, increased thrombin generation, massive release of plasminogen activator, hyperfibrinolysis, and gradual improvement with progressive disease. Improvement, but the patient is still hypercoagulable after treatment. u-PA, u-PAR can be used as an indicator of prognosis.