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[1]周妮娜,顾健辉,杨治平,等.止凝血指标变化与儿童初诊急性淋巴细胞白血病出血的关系[J].医学研究与战创伤救治(原医学研究生学报),2022,24(6):614-619.[doi:10.3969/j.issn.1672-271X.2022.06.011]
　ZHOU Ni-na,GU Jian-hui,YANG Zhi-ping,et al.Relationship between changes in hemostatic indicators and newly diagnosed acute lymphoblastic leukemia with hemorrhage in children[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(6):614-619.[doi:10.3969/j.issn.1672-271X.2022.06.011]
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止凝血指标变化与儿童初诊急性淋巴细胞白血病出血的关系()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年6期
页码:
614-619
栏目:
临床研究
出版日期:
2023-01-18

文章信息/Info

Title:
Relationship between changes in hemostatic indicators and newly diagnosed acute lymphoblastic leukemia with hemorrhage in children
作者:
周妮娜; 顾健辉; 杨治平; 盛俞; 姜荣
作者单位：226001南通，南通大学附属医院儿内科（周妮娜、顾健辉、杨治平、盛俞、姜荣）
Author(s):
ZHOU Ni-na;  GU Jian-hui;  YANG Zhi-ping; SHENG Yu;  JIANG Rong
（Department of Pediatric, Affiliated Hospital of Nantong University,Nantong 226001, Jiangsu，China）
关键词:
急性淋巴细胞性白血病; 出血; D-二聚体; 纤维蛋白原降解产物; 原始细胞
Keywords:
acute lymphoblastic leukemia;  hemorrhage;  D-dimer;  fibrinogen degradation product;  primitive cells
分类号:
R733.7
DOI:
10.3969/j.issn.1672-271X.2022.06.011
文献标志码:
A
摘要:
目的分析初诊急性淋巴性白血病（ALL）患儿的血小板（PLT）计数、凝血酶原时间（PT）、部分凝血活酶时间（APTT）、血浆纤维蛋白原（FIB）、血浆抗凝血酶III（AT-III）、血浆凝血酶时间（TT）、D-二聚体（D-D）及纤维蛋白原降解产物（FDP）等止凝血指标与出血的关系。方法选取2015年1月至2021年1月在南通大学附属医院确诊的41例ALL患儿作为观察组；依据是否出血分为出血亚组（n=18），未出血亚组（n=23）；根据出血的严重程度分为1级出血者（n=7），2级出血者（n=11）。随机选取同期行健康体检的41例儿童作为对照组。比较上述不同分组患儿止凝血功能指标，分析ALL出血与止凝血功能指标的关系及影响因素。结果观察组PLT为（85.43±24.42）×109/L，低于对照组的（310.52±52.87）×109/L，PT、FIB、D-D、FDP分别为（13.24±1.27）s、（5.65±1.84）g/L、（5.46±1.80）mg/L、（9.32±3.10）mg/L，均高于对照组的（11.05±1.22）s、（1.98±0.34）g/L、（0.29±0.07）mg/L、（3.01±0.79）mg/L（P<0.05）；出血亚组PLT为（73.99±10.75）×109/L，低于未出血亚组的（94.39±28.36）×109/L，PT、FIB、D-D、FDP和白细胞计数（WBC）及原始细胞比例分别为（14.50±0.88）s、（7.66±0.45）g/L、（7.34±0.80）mg/L、（11.81±3.14）mg/L、（21.40±4.27）×109/L、（47.28±5.69）%，均高于未出血亚组的（12.26±0.16）s、（4.07±0.30）g/L、（3.98±0.53）mg/L、（7.37±0.91）mg/L、（14.45±4.13）×109/L、（40.16±5.21）%（P<0.05）；2级出血者PLT为（68.27±7.57）×109/L，低于1级出血者的（82.97±8.82）×109/L，PT、FIB、D-D、FDP和WBC及原始细胞比例分别为（15.06±0.60）s、（7.88±0.31）g/L、（7.82±0.37）mg/L、（13.87±1.95）mg/L、（24.09±2.64）×109/L、（49.99±4.81）%，均高于1级出血者的（13.62±0.35）s、（7.32±0.30）g/L、（6.58±0.28）mg/L、（8.57±1.25）mg/L、（17.17±2.44）×109/L、（43.02±4.30）%（P<0.05）；Spearman等级相关结果示，PLT与ALL出血等级呈负相关（r=-0.416,P<0.05），PT、FIB、D-D、FDP、WBC和原始细胞比例与ALL出血等级呈正相关（r=0.427、0.486、0.455、0.433、0.409、0.507，P<0.05）；Logistic多因素回归分析示，PLT下降、PT、FIB、D-D、FDP升高和原始细胞比例增加是ALL患儿出血的危险因素（P<0.05）。结论初诊ALL出血患儿较未出血患儿PLT异常降低，PT、FIB、D-D、FDP、WBC和原始细胞比例升高，与出血程度有关；且PLT下降、PT、FIB、D-D、FDP升高和原始细胞比例是ALL患儿出血的危险因素。
Abstract:
ObjectiveThis study aims to analyze the relationship between hemostatic indicators such as platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen (FIB) and plasma antithrombin III (AT-III), plasma thrombin time (TT), D-dimer (D-D) and fibrinogen degradation product (FDP) and hemorrhage in children with newly diagnosed acute lymphoblastic leukemia (ALL).MethodsA total of 41 children with ALL who were diagnosed in the hospital between January 2015 and January 2021 were selected as the observation group, and they were divided into the hemorrhage group (n=18) and the non-hemorrhage group (n=23) according to whether hemorrhage occurred or not. The children in the hemorrhage group were classified into grade 1 hemorrhage group (n=7) and grade 2 hemorrhage group (n=11) by means of the severity of hemorrhage. Another 41 children who underwent physical examination during the same period were randomly enrolled as the control group. The hemostatic function indicators of children in different groups were compared, and the relationship between ALL with hemorrhage and hemostatic function indicators and its influencing factors were analyzed.ResultsThe level of PLT of (85.43±24.42)×109/L in the observation group was lower than that of (310.52±52.87)×109/L in the control group, and the levels of PT, FIB, D-D and FDP of (13.24±1.27) s, (5.65±1.84) g/L, (5.46±1.80) mg/L and (9.32±3.10) mg/L were higher than that of (11.05±1.22) s, (1.98±0.34) g/L, (0.29±0.07) mg/L and (3.01±0.79) mg/L in the control group (P<0.05). The PLT of (73.99±10.75)×109/L in the hemorrhage group was lower than (94.39±28.36)×109/L in the non-hemorrhage group while the levels of PT, FIB, D-D and FDP, white blood cell count (WBC) and the proportion of primitive cells of (14.50±0.88) s, (7.66±0.45) g/L, (7.34±0.80) mg/L, (11.81±3.14) mg/L, (21.40± 4.27)×109/L and (47.28±5.69)% were higher than (12.26±0.16) s, (4.07±0.30) g/L, (3.98±0.53) mg/L, (7.37±0.91) mg/L, (14.45±4.13)×109/L and (40.16±5.21)% in the non-hemorrhage group (P<0.05). The PLT of (68.27±7.57)×109/L in children in grade 2 hemorrhage group was lower than (82.97±8.82)×109/L in grade 1 hemorrhage group while the levels of PT, FIB, D-D and FDP, WBC and the proportion of primitive cells of (15.06±0.60) s, (7.88±0.31) g/L, (7.82±0.37) mg/L, (13.87±1.95) mg/L, (24.09±2.64)×109/L and (49.99±4.81)% were higher than (13.62±0.35) s, (7.32±0.30) g/L, (6.58±0.28) mg/L, (8.57±1.25) mg/L, (17.17±2.44)×109/L and (43.02±4.30)% in grade 1 hemorrhage group (P<0.05). Spearman rank correlation showed that PLT was negatively correlated with ALL hemorrhage grading (r=-0.416, P<0.05), and PT, FIB, D-D, FDP, WBC and the proportion of primitive cells were positively correlated with ALL hemorrhage grading (r=0.427, 0.486, 0.455, 0.433, 0.409, 0.507, P<0.05). Logistic multivariate regression analysis showed that decreased PLT, increased PT, FIB, D-D and FDP and the increased proportion of primitive cells were the risk factors for hemorrhage in children with ALL (P<0.05).ConclusionCompared with children without hemorrhage, children with newly diagnosed ALL and hemorrhage have abnormally decreased PLT and increased PT, FIB, D-D, FDP, WBC and proportion of primitive cells, which is related to the degree of hemorrhage. The decrease of PLT, the increases of PT, FIB, D-D and FDP and the proportion of primitive cells are the risk factors for hemorrhage in children with ALL.

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更新日期/Last Update: 2023-01-18