血栓标志物检测对急性髓系白血病并发DIC的风险评估的价值

目的:研究血栓标志物对急性髓系白血病(acute myelocytic leukemia,AML)患者并发弥散性血管内凝血(DIC)风险的评估价值.方法:回顾性分析2014年至2015年就诊于湖北省天门市第一人民医院的各类急性髓细胞白血病患者80例,采用CS5100型全自动血液凝仪测定血浆纤维蛋白原降解产物含量(FDP)、凝血因子Ⅷ活性(FⅧ:C)、抗凝血酶活性(AT:A)和血浆D-二聚体(D-D)水平.采用受试者工作特征曲线(ROC曲线)评价各项指标的诊断效能,对于疾病的预后因素分析采用Cox回归模型,采用Kaplan-Meier曲线进行生存分析.结果:除其他未分型的白血病外,各类AML患者中,M0、M1、M2、M3型FDP水平均明显高于对照组(P ＜0.05);M0、M1、M3、M4型及其它分型D-D水平均明显高于对照组(P ＜0.05);M1、M2、M3型FⅧ:C水平均明显高于对照组(P ＜0.05);M2、M3型AT:A水平高于对照组(P＜0.05);显性DIC组中,FDP诊断DIC时,ROC曲线下面积为0.923,95％ CI:0.867 ～ 0.979;FⅧ:C的ROC曲线下面积为0.623,95％ CI:0.522～0.742;AT:A的ROC曲线下面积为0.781,95％ CI:0.690～0.873;D-D的ROC曲线下面积为0.914,95％ CI:0.863 ～0.966:Cox比例风险模型显示,AML患者的年龄、化疗药物的使用、干细胞移植与否、血清中FDP以及D-D的浓度是AML患者发生DIC的危险因素(JP＜0.05).血浆FDP与D-D水平高于参考值范围上限时DIC累计发生概率显著增高,患者的生存时间较正常水平时间短.结论:AML患者血浆FDP与D-D水平显著增高,并与AML患者的DIC风险分层和DIC风险概率密切相关,具有良好的诊断性能,可作为评价恶性肿瘤患者随访6个月内DIC风险的有效指标.

Estimation of disseminated intravascular coagulation risk with thrombotic biomarkers in acute myelocytic leukemia

Objective:To assess the value of thrombotic biomarkers in estimation of disseminated intravascular coagulation(DIC) risk of acute myelocytic leukemia(AML).Methods:Retrospectively analyze the data of 80 AML patients.Using the SYSMEX CS5100 blood coagulation analyzer to detect the level of fibrin/fibrinogen degradation products (FDP),factor Ⅷ (F Ⅷ:C),antithrombin (AT:A),and D-dimer (D-D).Using the receiver opeating characteristic curve(ROC) to analyze the diagnostic performancer about these indicators.To evaluate the effect on the disease with cox regression model,usig Kaplan-Meier curve to implement the survival analysis.Results:In the AML patients,the level of FDP in M0,M1,M2,M3 type compared with the control group had significant difference(P ＜0.05),the level of FVⅧ:C in M1,M2,M3 type compared with the control group had significant difference (P ＜ 0.05).The level of AT:A in M2,M3 type compared with the control group has significant difference (P ＜ 0.05).Dominance of DIC,using the FDP to diagonse that the area under the ROC curve =0.923,95％ CI:0.867 ～0.979,the area under the ROC curve of FVⅧ:C =0.623,95 ％ CI:0.522 ～ 0.742,the area under the ROC curve of AT:A =0.781,95 ％ CI:0.690 ～ 0.873,the area under the ROC curve of D-D =0.914,95％ CI:0.863 ～0.966.Cox regression analysis model showed,age,chemotherapy,stem cell transplantation the level of FDP and D-D were the independent risker factors for DIC in AML patients (P ＜ 0.05).When the level of FDP and D-D over the upper limit reference,the cumulative probability was significantly higher,and the living time was shorter than the normal level.Conclusion:The level of FDP and D-D are obviously increased in AML patients,and it is closely related to DIC risk and cumulative proba bility,so it has a good diagnosis performance,and can be an effective marker to estimate the DIC risk of AML patients.