门冬酰胺酶治疗小儿急性淋巴细胞白血病过程中血栓弹力图的检测及其临床意义-东南大学学报医学版

门冬酰胺酶治疗小儿急性淋巴细胞白血病过程中血栓弹力图的检测及其临床意义

单位：贵州医科大学附属医院儿童血液肿瘤科, 贵州贵阳 550001

分类号：R733.71

出版年·卷·期（页码）：2019·38·第四期（643-646）

摘要：

目的：了解对急性淋巴细胞白血病（ALL）患儿使用门冬酰胺酶治疗后其体内出凝血状态，探讨引起这种变化的主要因素，为进一步指导临床治疗提供理论依据。方法：对使用门冬酰胺酶治疗后的ALL患儿在该药物的半衰期内使用血栓弹力图（TEG）检测体内的出凝血状态，并与对照组进行对比分析；将同期检测的活化部分凝血酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（Fib）、血小板（PLT）与TEG中的综合凝血指数（CI）进行相关性分析。结果：146例次中114例次CI呈低凝状态，32例次凝血功能正常。低凝中输注冰冻血浆有47例，输注血小板21例。治疗前存在严重血小板低下（PLT≤20×10⁹L^-1）16例，低纤维蛋白原血症[ρ（Fib）≤1.0 g·L^-1]6例，感染1例，转氨酶升高15例，置管116例。对照组20例TEG的各参数均正常。门冬酰胺酶治疗组K值明显高于对照组，ɑ角、MA值、CI值明显低于对照组，差异均具有统计学意义（均P<0.01）。TEG中的CI值与Fib、PLT、PT相关（r分别为0.449、0.303、-0.235，均P<0.05）。结论：采用门冬酰胺酶治疗后ALL患儿总体处于低凝状态，主要表现是纤维蛋白原水平及活性低下，其次为血小板数量及功能低下。在治疗过程中可根据TEG检测来指导临床输血，避免患儿发生严重出血。

Objective: Thrombelastogram(TEG) was used to detect the varing trend of internal bleeding and clotting function of child patients with acute lymphoblastic leukemia(ALL) after asparaginase treatment, the main factors causing the change were also discussed in order to provide a theoretical basis for further guiding clinical treatment. Methods: The coagulation status of ALL children treated with asparaginase during the half-life of the drug was detected by TEG, and the parameters of TEG were compared with those of the control group. The correlation between the APTT,PT,Fib,PLT detected at the same time and the integrated coagulation index(CI) in TEG was analyzed. Results: Of 146 cases, 114 had low coagulation index and 32 had normal coagulation function. Frozen plasma was infused in 47 cases and platelet transfusion in 21 cases. Before treatment, there were 16 cases with severe thrombocytopenia(PLT ≤ 20×10⁹L^-1), 6 cases with low fibrinogenemia[ρ(Fib) ≤ 1.0 g·L^-1], 1 case with infection, 15 cases with elevated transaminase, and 116 cases with catheterization. The parameters of TEG in 20 cases of the control group were normal. Compared with the control group, the TEG of the asparaginase treatment group was significantly higher than that of the control group(P<0.01). The K value of the asparaginase treatment group was significantly higher than that of the control group(P<0.01). The values of K, MA and CI were significantly lower than those of the control group(P<0.01). The correlation coefficients of PT were 0.449, 0.303 and 0.235, respectively(P<0.05). Conclusion: After treatment with asparaginase, the results of TEG show that the children with ALL are in a state of hypocoagulability, which mainly result in low fibrinogen level and activity, followed by low platelet count and function, thus showing a state of hypocoagulability. In the course of treatment with asparaginase, the clinical blood transfusion can be guided according to the comprehensive coagulation status detected by TEG, so as to avoid the severe bleeding of the patient.

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