急性白血病患者乳酸脱氢酶变化的临床意义

 目的　观察急性白血病（AL）患者血清乳酸脱氢酶（LDH）的变化，探讨其对AL疗效和预后判断的临床意义。方法　采用全自动生化分析仪检测156例AL患者包括初治组63例、完全缓解（CR）组46例、复发组47例]的LDH值，常规反带方法分析AL染色体核型，并根据核型分成预后好、预后中等及预后差3组，分析LDH值与上述分组、患者白细胞数及白血病亚型的相关性。结果　初治组和复发组的AL患者血清LDH值其中位数（P50）分别为399和265 U／L]明显高于CR组（P50 153 U／L）（P＜0.05）。LDH的增高与外周血白细胞数（rs＝0.604）及骨髓中白血病细胞比例（rs＝0.538）密切相关（均P＜0.01）。LDH与不同白血病亚型有关（L2、M4明显增高）（P＜0.01）。难治复发的AL患者初治时LDH值（P50 538 U／L）高于非难治复发组（P50 294 U／L）。具有不良预后染色体核型的AL患者初治时LDH（P50 778 U／L）明显高于预后良好组（P50 306 U／L）和预后中等组（P50 405 U／L）（P＜0.01）。结论　LDH在AL发病时明显升高，其升高程度与病期、亚型及恶性度有相关性，AL缓解期LDH可下降，LDH可作为AL诊治过程中判断病情、评估预后的参数。

Clinical significance of serum lactic dehydrogenase alteration in patients with acute leukemia

Objective To investigate the clinical significance of serum lactic dehydrogenase （LDH） alteration in patients with acute leukemia （AL）. Methods Serum LDH of 156 AL patients including untreated 63,completely remission （CR） 46 and relapsed 47 were measured by biochemistry analyzer. R banding technique was used for karyotype analysis this three groups were divided according to poor, good and normal prognostic chromsome. The correlation between LDH level with AL periods, chromsome groups, peripheral WBC counts and leukemia subtypes were analysed. Results The LDH level of AL patients untreated （P50 399 U/L） and relapsed （P50 265 U/L） were significantly higher than those CR （P50 153 U/I,）, P 〈0.05. LDH level were closely correlated with peripheral WBC counts （rs=0.604） and leukemia cells of bone marrow （rs= 0.538, both P 〈 0.01）, and both were also correlated with leukemia subtypes （LDH in subtypes I~, M4 were higher than other subtypes of AL, P 〈 0.01）. The refractory and relapsed AL patients had higher LDH level （P50 538 U/L） than the others （P50 294 U/L） when they were diagnosed. And those with poor prognostic chromsome also had higher LDH level （P50 778 U/L） than those with good （P50 306 U/L） and normal prognostic chromsome （P50 405 U/L, P 〈0.01）. Conclusion LDH level increased obviously in untreated AL patients and decreased in CR ones.It was correlated with different periods, subtypes and grade malignancy of AL. So LDH level can be considered as an important indieator for therapeutic effects and prognosis for AL oatients.