Rodeghiero F, Castaman G, Soffiati G, Quaglio R, Castronovo S, Cortesi S, Dini E
Department of Haematology and Haemophilia, San Bortolo Hospital, Vicenza, Italy.
Blut. 1989 Aug;59(2):177-83. doi: 10.1007/BF00320064.
Fibrinopeptide A (FPA) was systematically investigated in 74 patients with acute leukaemia at different stages of the disease (50 with non-lymphocytic leukaemia, ANLL; 24 with lymphocytic leukaemia, ALL). At diagnosis, 75% of the cases had high FPA levels (86% in ANLL and 54% in ALL) with significantly higher levels in ANLL than in ALL (13.4 vs 4.4 ng/ml; p less than 0.001). Patients with DIC (20 cases in ANLL and 1 case in ALL) had significantly higher levels (p less than 0.001). FPA levels were neither correlated with fibrinogen or FDP levels nor with blast cell count. During chemotherapy, median FPA did not show significant changes whereas, at the end of therapy, a return toward normality was generally observed both in ALL and ANLL apart from the group of patients with acute promyelocytic leukaemia. Among the 24 patients who entered post-remission follow-up (13 ANLL and 11 ALL), 10 cases out of the 11 relapsing (6/6 with ANLL and 4/5 with ALL) had increased FPA 1 to 2 months before the ascertainment of the relapse. However, 16% and 9% of the samples obtained on different occasions, respectively from ANLL and ALL cases in maintained first remission, showed FPA above the normal limit. This study demonstrates that subclinical activation of blood coagulation, as indicated by high FPA level, is common both in lymphocytic and non-lymphocytic leukemia and suggests that this phenomenon is related to disease activity.
对74例处于疾病不同阶段的急性白血病患者（50例非淋巴细胞白血病，ANLL；24例淋巴细胞白血病，ALL）进行了纤维蛋白肽A（FPA）的系统研究。诊断时，75%的病例FPA水平较高（ANLL中为86%，ALL中为54%），ANLL中的水平显著高于ALL（13.4对4.4 ng/ml；p<0.001）。发生弥散性血管内凝血（DIC）的患者（ANLL 20例，ALL 1例）水平显著更高（p<0.001）。FPA水平既与纤维蛋白原或FDP水平无关，也与原始细胞计数无关。化疗期间，FPA中位数未显示出显著变化，而在治疗结束时，除急性早幼粒细胞白血病患者组外，ALL和ANLL患者一般都观察到FPA恢复正常。在进入缓解后随访的24例患者（13例ANLL和11例ALL）中，11例复发患者中有10例（ANLL中6/6，ALL中4/5）在复发确诊前1至2个月FPA升高。然而，分别从处于首次缓解期的ANLL和ALL病例不同时间采集的样本中，有16%和9%的FPA高于正常上限。本研究表明，高FPA水平所表明的血液凝固亚临床激活在淋巴细胞白血病和非淋巴细胞白血病中都很常见，并提示这种现象与疾病活动有关。
