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1、白血病病人血栓前状态分子标志物的变化及临床意义【关键词】白血病;血栓前状态;D-二聚体;膜蛋白质类;vWF;抗凝血酶III［摘要］目的观察白血病病人凝血、抗凝及纤溶指标的变化，以探讨凝血系统的变化与白血病并发出血的关系。方法采用酶联免疫吸附法,检测了86例初发白血病病人的血浆D-二聚体(D-D)、血小板a颗粒膜蛋白-140(GM卩-140)、血管性血友病因子：抗原(vWF:Ag)的含量，发色底物法检测抗凝血酚III(AT-III)活性，并与45例健康人比较。结果白血病病人血浆D-D、GMP-140、vWF:Ag含量明显升高，与对照组比较差异有显著性(t=9.208〜10.7
2、82,卩<0.001),且急性非淋巴细胞性白血病(ANLL)病人各指标变化明显高于急性淋巴细胞性白血病(ALL)及慢性白血病病人(t=5.237-31.598,P<0.001),而ANLL病人AT-III活性明显低于ALL、慢性白血病病人及对照组(t二9.857〜19.963,P<0.001),慢性白血病病人除了vWF:Ag含量高于对照组外(1=2.534,卩<0.05),其余各指标与对照组比较差异无显著性(t二0.301〜1.889,P>0.05)o白血病病人血浆GMP-140、vWF：Ag、D-D、AT-III活性水平之间呈明显的相关性(r
3、二-0.759〜0.915,P<0.05>0.01)。结论白血病病人存在明显的高凝状态，表现为血小板活性增加及血管内皮细胞损伤，抗凝活性降低及继发纤溶功能亢进。［关键词］白血病；血栓前状态；D-二聚体;膜蛋白质类;vWF;抗凝血酶III[ABSTRACT]ObjectiveToexploretherelationshipbetweenincidenceofhemorrhageinpatientswithleukemiaandchangesofthemarkersofcoagulation,anticoagulationandfibrinolysis.MethodsPl
4、asmaplateletgranularmembraneprotein140(GMP-140),vonWillebrandfactorAg(vWFIAg),D-dimer(D~D)weredetectedbyEnzymeLinkedImmunosorbentAssay(ELISA),Anti-thrombinIII(AT-III)activitybychromogenicsubstratemethodin86patients・TheresuItswerecomparedwith45healthysubjects.ResultsThelevelsofplasmamembran
5、eproteins,vWF:Ag,D~Dweresignificantlyelevatedinthepatientsanddif-feredsignificantlyfromthecontrol(t=9.208-10.782,P&It;0.001)・ThechangesofmolecularmarkersinpatientswithANLLwereelevatedsignificantlythanthosewithALLandchronicleukemia(t二5.237-31・598,P<0・001)・ThelevelsofplasmaAT-IIIactivityi
6、npatientswithANLLwerelowersignific且ntlythanthosewithALL,chronicleukemiaandcontrolgroup(t二9.857-19.963,P<0.001).Therewasnosignificantdifferencebetweenpatientswithchronicleukemiaandthecontrols(t=0.301-1.889,卩>0.05)exceptthelevelsofvWF；Ag(t=2・534,P<0.05).Thereweresignificantcorrelati
7、onsbetweenthemolecularmarkersinpatientswithleukemia(r=~0.759-0.915;P<0.01,0.05)•ConclusionThereexistsanobvioushypercoagulablestateinpatientswithleukemiaeTheactivationofplatelet,fibrinolyticsystemandtheinjuryofvascularendotheliuminpatientswithleukemiamaybeth
