| Objective: Acute Leukemia(AL) is a malignant cloning disease occurred in hematopoietic stem cells. AL divides into two categories, Acute Myeloid Leukemia(AML) and Acute Lymphoblastic Leukemia(ALL). Leukemia contributes to the sixth mortality rate in female population and the eighth in male population among all domestic cancer deaths. However, among children and the age group below 35 years old, it contributes to the first place in population mortality rate. Bleeding has proven to be a important reason of early death in Acute Leukemia cases. Clinically, laboratory examination on clotting index is often used to help determine the possibility of a hemorrhage clinically. However, it is still unclear to us how do anticoagulant, fibrinolytic and blood coagulation systems function between AML and ALL, children AL and adults AL, before and after the treatment of AL. Through observation of the changes in the anticoagulant, fibrinolytic and blood coagulation indexes of AML and ALL, child AL patients and adult Al patients, analysis of the correlation between the blood coagulation indexes of each group, reviling abnormality in anticoagulant, fibrinolytic and blood coagulation systems of AL patients of different type and through discussion of bleeding danger factors of patients, clarify the mechanisms of thrombosis and hemorrhage in a deep insight, this research provides important theoretical evidence of the progression, efficacy and prognosis of all types of AL.Methods:This study is conducted on the 141 cases of hospitalized Acute Leukemia patients between 2014.1-2014.12 in our hospital. All cases are divided into 6 groups by the diagnostic classification of AL.Adult Acute Myeloid Leukemia(AML)(n = 67, M2 24 cases, M3 27 cases, M4 6 cases, M5 8 cases and 1 of both M6 and M0) Male: 39. Female:28. Age: 18 ~ 85. Median age: 45.Adult Acute Lymphoblastic Leukemia(ALL)(n = 30) Male: 15. Female: 15. Age: 18 ~ 68. Median age: 28.Child Acute Myeloid Leukemia(AML)(n = 24) Male: 9. Female: 15. Age: 1 ~ 17.Median age: 5. Child Acute Lymphoblastic Leukemia(ALL)(n = 36) Male:18. Female: 18. Age: 1 ~ 17. Median age: 7. Adult Normal Control Group(n =53) Male: 31. Female: 22. Age: 23 ~ 88. Median age: 43. All members are selected from healthy adults of no cardiovascular disease, diabetes and other major diseases.Child Normal Control Group(n = 32) Male: 13. Female: 19.Age: 2 ~ 17. Median age: 23.11 cases of children AL, 17 cases of adults AL and 34 cases of adults AML were analyzed in the same time.All groups above had their expression levels of DD, FDP, Fib, APTT, PT,TT and AT plasma. Apply immune turbidimetric method for the quantitative detection of D-dimer, FDP. Apply solidification method of quantitative detection of APTT, Fib, PT and TT. Apply hair color substrate method to detect AT.Results:1 The results of adult Acute Leukemia groups.Comparing with normal control group, adult AML group’s PT is obviously prolonged(P < 0.01). APTT is significantly shortened(P < 0.05).AT activity is significantly lowered(P < 0.01). Also the level of D-dimer,FDP rises significantly(P < 0.01). Fib increased slightly, but the difference has no statistical significance(P > 0.05). There is no obvious difference in TT.Comparing with normal control group, adult ALL group’s PT is obviously prolonged(P < 0.05). AT activity is significantly lowered(P <0.05). The level of D-dimer, FDP rises significantly(P < 0.01). APTT is shorten, and Fib is increased but without statistical significance. TT has no obvious difference.Compared with ALL group, patients in AML group’s PT is increased(P< 0.01). There are no significant differences in other indicators. The results are shown in table 1, 2.2 The results of child Acute Leukemia groups.Comparing with normal control group, child AML group’s PT is obviously prolonged(P < 0.01). TT is prolonged(P < 0.05). The level of D-dimer, FDP rises significantly(P < 0.01). There is no obvious differences in APTT, AT and Fib.Comparing with normal control group, child AML group’s PT is obviously prolonged(P < 0.01). D-dimer rises significantly(P < 0.01). There is no obvious differences in PT, APTT, AT and Fib.Compared with ALL group, patients in AML group’s PT is increased(P< 0.01). There are no significant differences in other indicators. The results are shown in table 1, 2.3 Comparison between adults and children Acute Leukemia patients.No significant difference is found in both adults and children groups and ALL and AML groups. The results are shown in table 3.4 The indicators before and after the treatment of the acute leukemia.Compared with patients before treatment, patients after treatment have their PT shortened(P < 0.05). DD, FDP level is significantly reduced(P <0.01). The patient’s blood coagulation and fibrinolytic indexes are recovered after treatment. The results are shown in table 4.5 Compared with patients except M3, M3 patients in AML group has their APTT significantly shortened(P <0.01). TT is significantly prolonged(P< 0.01). AT activity is significantly increased(P < 0.01). D-dimer and FDP levels rise obviously(P < 0.01). Fib levels decreased significantly(P < 0.01).The results are shown in table 5.Conclusions:1 Acute leukemia patients’ blood coagulation- anticoagulation-fibrinolytic system is abnormal. Regardless of adult or child, patients of AML group’s PT are prolonged than patients of ALL’s PT.2 There are no significant differences between adult groups and child groups.3 7 days after the treatment, Al patients’ PT is significantly shorter; DDand FDP levels are significantly lowered. There are no observable differences in other indexes. |
