摘要
目的探讨恶性血液病初诊时凝血指标及白细胞、血小板等变化的临床意义。方法收集2012年1月至2018年8月在玉溪市人民医院确诊恶性血液病患者初诊时PT,FIB,APTT,ATⅢ,FDP,D-D及WBC,PLT等检测资料并整理、分析。结果526例恶性血液病包括急性白血病(AL)243例,慢性白血病(CL)92例,淋巴瘤34例,多发性骨髓瘤(MM)59例,再生障碍性贫血(AA)37例,骨髓增生异常综合征(MDS)61例。526例中≥1项凝血指标异常者430例,占81.75%。6项凝血指标异常率由高到低依次是D-D 54.00%(236/437),PT 44.30%(233/526),FIB 43.35%(228/526),FDP 39.93%(119/298),APTT 37.26%(196/526),ATⅢ30.38%(96/316)。各凝血指标组间比较:AL组与CL组FIB,FDP,D-D差异有统计学意义(t=3.89~6.78,均P<0.01);白血病组与非白血病组ATⅢ,FDP,D-D差异有统计学意义(t=3.03~3.86,均P<0.01)。482例血细胞计数WBC 0.12×10^9/L^792.97×10^9/L,377例PLT 2.0×10^9/L^935.0×10^9/L。526例中272例伴出血(51.71%),出血发生率:WBC<4.0×10^9/L者高(占60.90%),PLT≤30.0×10^9/L者最高(占96.84%);白血病组出血发生率高于非白血病组,白血病组以AML-M3型最高(69.77%);非白血病组中AA最高(70.27%);出血发生率随凝血指标异常项增多而增高。≥3项异常出血发生率及2级出血发生率,白血病组均高于非白血病组(χ^2=5.22,P<0.05;χ^2=8.39,P<0.01)。结论①恶性血液病初诊时大部分有1项及以上凝血指标异常(81.75%),凝血指标异常以D-D最敏感。②出血发生率:WBC,PLT减少者较高,且随PLT减少而增加;白血病比非白血病高,以M3型最高;随凝血指标异常项增多而增高。
Objective To explore malignant blood disease the clinical significance of coagulation indicators and changes in white blood cells and platelets at the time of initial diagnosis. Methods Collected test dates of PT,FIB,APTT,ATIII,FDP,D-D,WBC,PLT in patients with malignant hematological diseases diagnosed at the inilied diagnosis in Yuxi People’s Hospital from January 2012 to August 2018 and they collated and analyzed. Results 526 cases of malignant hematological diseases included 243 cases of acute leukemia( AL),92 cases of chronic leukemia( CL),34 cases of lymphoma,59 cases of multiple myeloma( MM),37 cases of aplastic anemia( AA) and abnormal myelodysplasia Syndrome( MDS) in 61 cases.Of the 526 cases,there were 430 cases of ≥1 had abnormal blood coagulation index,accounting for 81. 75%. The abnormal rate of 6 coagulation indicators from high to low was DD 54. 00%( 236/437),PT 44. 30%( 233/526),FIB 43. 35%( 228/526),FDP 39. 93%( 119/298),APTT 37. 26 %( 196/526) and ATIII 30. 38%( 96/316),respectively. Each coagulation indicators comparison between groups: There were statistically significant difference in FIB,FDP and D-D between the AL group and the CL group( t = 3. 89 ~ 6. 78,all P < 0. 01). There were statistically significant difference in ATIII,FDP and D-D between the leukemia group and the non-leukemia group( t = 3. 03 ~ 3. 86,all P < 0. 01). In 482 cases of blood routine WBC 0. 12 × 10~9/L ~ 792. 97 × 10~9/L,377 cases of PLT 2. 0 × 10~9/L ~ 935. 0 × 10~9/L. Of the 526 cases,272 had bleeding( 51. 71%). Bleeding occur rate: the patient WBC was < 4. 0 × 10~9/L bleeding occur rate for high( 60.90%),the patient PLT was ≤30. 0 × 10~9/L bleeding occur rate for highest( 96. 84%). The incidence of bleeding in the leukemia group was higher than in the non-leukemia group,AML-M3 type( 69. 77%) was highest in the-leukemia group,and AA( 70. 27%) was highest in the non-leukemia group. The incidence of bleeding increased with the increase in abnormalities item in the coagulation indicators. The incidence of blee
作者
朱理平
朱理佳
王永志
潘宝龙
朱士红
孙竞
HU Li-ping;ZHU Li-jia;WANG Yong-zhi;PAN Bao-long;ZHU Shi-hong;SUN Jing(Department of Hematology,the Sixth Affiliated Hospital of Kunming Medical UniversityYuxi People’s Hospital,Yunnan Yuxi 653100,China;Department of ClinicalLaboratory,the Sixth Affiliated Hospital of Kunming Medical UniversityYuxi People’s Hospital,Yunnan Yuxi 653100,China;Yuxi Children’s Hospital,Yunnan Yuxi 653100,China;Department ofHematology,Southern Hospital of Southern Medical University,Guangzhou 510515,China)
出处
《现代检验医学杂志》
CAS
2020年第1期105-110,共6页
Journal of Modern Laboratory Medicine
关键词
恶性血液病
初诊
凝血指标
malignant blood disease
newly diagnosed
coagulation indicators
