疾病与化疗对急性淋巴细胞白血病患儿止血的影响。

L G Mitchell, J M Halton, P A Vegh, R D Barr, T Venneri, K M Pai, M E Andrew
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引用次数: 0

摘要

目的:我们试图确定疾病和联合化疗对儿童急性淋巴细胞白血病(ALL)止血系统的影响。患者和方法:我们对新诊断为ALL的儿童进行了一项前瞻性研究。在四个时间点采集血浆样本:治疗前诊断时、单独使用l -天冬酰胺酶后5天、缓解诱导计划后和巩固期完成时。测定血浆中21种止血蛋白的水平。用APTT试剂激活后产生的凝血酶的量被定量。结果:在诊断时,因子VIII、IX、血管性血友病、α 2-巨球蛋白和蛋白s显著升高,而蛋白C、钾化因子preklikrein、因子XIIIA和XIIIS显著降低。l -天冬酰胺酶单独处理降低了11种蛋白的浓度,其中抗凝血酶III受到的影响最大。在多药化疗后,不包括l -天冬酰胺酶,大多数蛋白质浓度增加到或高于基线。在完成巩固治疗时,包括每周给药l -天冬酰胺酶,大多数蛋白质的浓度与基线值相比下降。用APTT试剂激活后产生的凝血酶的量与成人相似。结论:凝血蛋白浓度受疾病(ALL)单独和联合化疗(含或不含l -天冬酰胺酶)的影响。体外生成凝血酶的能力没有受损。单独使用l -天冬酰胺酶会导致几乎所有蛋白质的减少;而ATIII受影响最大。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of disease and chemotherapy on hemostasis in children with acute lymphoid leukemia.

Purpose: We sought to determine the effect of disease and combination chemotherapy on the hemostatic system in children with acute lymphoid leukemia (ALL).

Patients and methods: We conducted a prospective study of children newly diagnosed with ALL. Plasma samples were obtained at four time points: at diagnosis before therapy, 5 days after administration of L-asparaginase alone, after the remission induction program, and at completion of the consolidation phase. Plasma levels of 21 hemostatic proteins were measured. The amount of thrombin generated following activation with an APTT reagent was quantitated.

Results: At diagnosis there were significant elevations in factors VIII, IX, von Willebrand, alpha 2-macroglobulin and protein S. In contrast, there were significant reductions in protein C, prekallikrein, and factors XIIIA and XIIIS. L-asparaginase treatment alone decreased concentrations of 11 proteins, with antithrombin III being affected to the greatest extent. After multiagent chemotherapy, not including L-asparaginase, concentrations of most proteins increased to or above baseline. At completion of consolidation therapy, which included weekly L-asparaginase administration, concentrations of most proteins were decreased compared with baseline values. The amount of thrombin generated following activation with an APTT reagent was similar to adults.

Conclusion: Plasma concentrations of coagulation proteins are affected by disease (ALL) alone and by combination chemotherapy with or without L-asparaginase. There is no impairment of in vitro capacity to generate thrombin. L-asparaginase alone caused a decrease in almost all proteins; however, ATIII was affected to the greatest extent.

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