Higuchi T, Shimizu T, Mori H, Niikura H, Omine M
Division of Hematology, Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
Hematol Oncol. 1997 Nov;15(4):209-17. doi: 10.1002/(sici)1099-1069(199711)15:4<209::aid-hon615>3.0.co;2-s.
Coagulation patterns of 19 newly-diagnosed acute promyelocytic leukemia (APL) patients with disseminated intravascular coagulation (DIC) at presentation were studied. Seventeen patients had hemorrhagic complications, of which four were fatal. Fatal hemorrhages were related with lower fibrinogen level and lower platelet count. DIC of the APL patients without infection was characterized by low fibrinogen and normal antithrombin III (ATIII) level. Thrombin-ATIII complex level was elevated in all patients examined. Patients with infection had higher fibrinogen levels than those without infection and some patients had reduced ATIII level. Ten remission inductions were tried with multidrug chemotherapy and seven with all-trans retinoic acid (ATRA). Complete remission was achieved in seven of ten inductions with chemotherapy and in all seven inductions with ATRA. Two patients treated with chemotherapy had fatal hemorrhage after starting therapy but none treated with ATRA.
对19例初诊时伴有弥散性血管内凝血（DIC）的急性早幼粒细胞白血病（APL）患者的凝血模式进行了研究。17例患者出现出血并发症，其中4例死亡。致命性出血与较低的纤维蛋白原水平和较低的血小板计数有关。无感染的APL患者的DIC特点是纤维蛋白原水平低，抗凝血酶III（ATIII）水平正常。所有接受检查的患者凝血酶-ATIII复合物水平均升高。有感染的患者纤维蛋白原水平高于无感染的患者，部分患者ATIII水平降低。10例患者尝试采用多药化疗进行缓解诱导，7例采用全反式维甲酸（ATRA）进行诱导。10次化疗诱导中有7例实现完全缓解，7次ATRA诱导均实现完全缓解。2例接受化疗的患者在开始治疗后发生致命性出血，但接受ATRA治疗的患者均未出现此类情况。
