【摘要】 目的探讨活化血浆凝固时间(APCT)对恶性血液病化疗后血小板减少所致出血的预示作用。方法将42例恶性血液病化疗后血小板计数(PLT)均<50×109/L的住院患者,根据有无出血表现分为两组:出血组16例,无出血组26例。抽取患者静脉血4 ml,以3.8%枸橼酸钠抗凝后进行PLT和APCT测定。结果出血组和无出血组的PLT和APCT分别为(8.3±4)×109/L、(103±7.8)s,(23±12)×109/L、(70±8.5)s,出血组患者的APCT比无出血组明显延长,两者比较差异有统计学意义(P<0.01)。以APCT≥90 s为界点值,预示血小板减少所致出血的敏感性100%,特异性100%;以PLT<20×109/L为界点值,敏感性为100%,特异性为42.3%。结论 APCT是血小板预防性输注的良好指标,其预示血小板减少所致出血的特异性显著优于血小板计数,预防性血小板输注的阈值确定为APCT≥90 s是安全有效的。更多还原

【Abstract】 Objective To investigate the predictive effect of activated plasma clotting time( APCT) upon thrombocytopenic bleeding after chemotherapy for malignant hematologic diseases. Methods 42 cases of hospitalized patients suffering from hematologic malignancies with platelet count( PLT) < 50 × 109/ L after chemotherapy were divided into two groups,according to whether they bled. The bleeding group included 16 cases and the non-bleeding group 26. 4ml venous blood was drawn and anti-coagulated in 3. 8% sodium citrate before PLT and APCT tests were performed. Results For the bleeding and non-bleeding groups,the PLT and APCT were( 8. 3 ± 4) × 109/ L,( 103 ± 7. 8) s;( 23 ± 12) × 109/ L,( 70 ± 8. 5) s respectively. The APCT of bleeding group patients was significantly longer than the non-bleeding group. There was significant difference between the two groups( P < 0. 01). If APCT≥90s was set as the boundary point value,the sensitivity predicting thrombocytopenic bleeding was 100% and specificity 100%; IF PLT < 20 × 109/ L was set as the boundary point value,the sensitivity was100% and specificity 42. 3%. Conclusion APCT is a good predictor of prophylactic platelet infusion,which indicates the specificity of thrombocytopenic bleeding is significantly superior to PLT. APCT≥90s set as the threshold value for prophylactic platelet infusion is safe and effective.更多还原