【摘要】 目的:分析左旋门冬酰胺酶与培门冬酶对成人急性淋巴细胞白血病患者凝血功能的影响及其相关因素。方法:回顾性分析2010年1月至20巧年1月共153例初治急性淋巴细胞白血病患者的临床资料,其中108例接受左旋门冬酰胺酶治疗,45例接受培门冬酶治疗。比较两组患者治疗后凝血功能变化及并发症的发生率,并分析左旋门冬酰胺酶不同使用时间对以上因素的影响。结果:接受左旋门冬酰胺酶或培门冬酶治疗的两组患者在年龄、性别、初发时白细胞数、原发疾病类型、危险因素分层、总有效率及相关并发症无统计学差异(P>0.05)。培门冬酶与左旋门冬酰胺酶治疗过程中输注血浆、冷沉淀、纤维蛋白原(FIB)的总量均无统计学差异(P=0.12,0.65,0.09),培门冬酶使用后纤维蛋白原下降速度较左旋门冬酰胺酶下降的速度慢(9.49 vs 6.90,P=0.000)。左旋门冬酰胺酶早期间断使用时FIB下降较晚,出血风险较高,差异有统计学意义(P=0.01,0.013)。结论:培门冬酶较左旋门冬酰胺酶能更好地检测凝血功能变化,左旋门冬酰胺酶间断使用时较易检测凝血功能变化,但早期使用时并发症的发生率增加。更多还原

【Abstract】 Objective:To analyze the coagulation function and relevant factors of adults patients with acute lymphoblastic leukemia treated with pegasparase(PEG-ASP) or L-asaraginase(L-ASP).Methods:The clinical features of 153 patients with acute lymphoblastic leukemia(ALL) received L-ASP or PEG-ASP in our hospital from January 2010 to January 2015 year were analyzed retrospectively.Among 153 patients,108 patients received L-ASP treatment and 45 patients received PEG-ASP treatment.The change of coagulation function and the incidence of complications of 2 treated groups were compared,and the influence of differenent using time of L-ASP on above mentioned factors were analyzed.Results:The age,sex,white blood cell count(WBC) at diagnosis,subtype and risk factors of disease,total effective rate and complication rates showed no significant difference in the 2 groups(P >0.05).The total infusion of fresh frozen plasma(FFP),cryoprecipitate and fibrinogen(FIB) also showed no significant difference(P =0.12,0.65,0.09).FIB levels decreased slower after treatment of PEG-ASP(9.49 vs 6.90)(P = 0.000) than that after treatment of L-ASP.When L-ASP used at interval,FIB level decreased slower than that of continuous use.However,the risk of bleeding is higher when used at interval early(P =0.01,0.013).Conclusion:Using PEG-ASP can better monitor the coagulation function than L-ASP.L-ASP used at interval can monitor the coagulation function easily,but its early use may cause an increased incidence of complications.更多还原