CAJ | 학술논문

目的探讨连续流动离心式血液成分分离机高量减除白细胞治疗对高白细胞性白血病患者综合性凝血指标及血浆纤维蛋白原浓度的影响.方法采用COBE Spectra连续流动离心式血液成分分离机单个核细胞(MNC)采集程序,以ACD-A配方血液保存液作为抗凝剂,对高白细胞性白血病患者实施减除白细胞治疗,每次治疗运转2.523.0倍总血量,采集20％～25％总血容量的白细胞悬液,对39例患者共进行56次减除白细胞治疗.结果单次治疗运行时间(233.63±27.41) min,运转血量(12 268.77±1 978.25)ml,ACD-A配方血液保存液用量(991.04±185.06)ml,采集白细胞悬液容量(922.89±213.26)ml,悬液中白细胞计数[中位数(四分位数间距)]为551.05×109/L(396.76×109/L,756.45 × 109/L),单次治疗减除白细胞总数为491.52×109(341.53×109,754.51×109);治疗前、后患者白细胞计数分别为233.30×109/L(163.62×109/L,367.05×109/L)、167.34×109/L(94.40×109/L.260.06×109/L) (s=765,P＜0.001),凝血酶原时间(PT)分别为(15.69±2.82)s、(15.81 ±2.71)s(t=1.25,P＞0.05),活化部分凝血活酶时间(aPTT)分别为(39.22±8.15)s、(39.87±7.97)s(t=1.96,P＞0.05),凝血酶时间(TT)分别为(17.35±1.73)s、(17.48±1.57)s(t=1.77,P＞0.05),纤维蛋白原浓度(Fbg)分别为(2.91±1.00)g/L、(2.61±0.81)g/L(t=7.49,P＜ 0.001).结论采用连续流动离心式血液成分分离机对高白细胞性白血病患者实施高量(20％～25％总血容量)减除白细胞治疗,可降低患者体内白细胞负荷,同时可降低患者血浆Fbg,但降低值在机体维持正常止血功能的代偿范围内,对反映患者内、外源性凝血活性的综合性凝血指标无明显影响.
목적 탐토련속류동리심식혈액성분분리궤고량감제백세포치료대고백세포성백혈병환자종합성응혈지표급혈장섬유단백원농도적영향.방법 채용COBE Spectra련속류동리심식혈액성분분리궤단개핵세포(MNC)채집정서,이ACD-A배방혈액보존액작위항응제,대고백세포성백혈병환자실시감제백세포치료,매차치료운전2.523.0배총혈량,채집20％～25％총혈용량적백세포현액,대39례환자공진행56차감제백세포치료.결과 단차치료운행시간(233.63±27.41) min,운전혈량(12 268.77±1 978.25)ml,ACD-A배방혈액보존액용량(991.04±185.06)ml,채집백세포현액용량(922.89±213.26)ml,현액중백세포계수[중위수(사분위수간거)]위551.05×109/L(396.76×109/L,756.45 × 109/L),단차치료감제백세포총수위491.52×109(341.53×109,754.51×109);치료전、후환자백세포계수분별위233.30×109/L(163.62×109/L,367.05×109/L)、167.34×109/L(94.40×109/L.260.06×109/L) (s=765,P＜0.001),응혈매원시간(PT)분별위(15.69±2.82)s、(15.81 ±2.71)s(t=1.25,P＞0.05),활화부분응혈활매시간(aPTT)분별위(39.22±8.15)s、(39.87±7.97)s(t=1.96,P＞0.05),응혈매시간(TT)분별위(17.35±1.73)s、(17.48±1.57)s(t=1.77,P＞0.05),섬유단백원농도(Fbg)분별위(2.91±1.00)g/L、(2.61±0.81)g/L(t=7.49,P＜ 0.001).결론 채용련속류동리심식혈액성분분리궤대고백세포성백혈병환자실시고량(20％～25％총혈용량)감제백세포치료,가강저환자체내백세포부하,동시가강저환자혈장Fbg,단강저치재궤체유지정상지혈공능적대상범위내,대반영환자내、외원성응혈활성적종합성응혈지표무명현영향.
Objective To explore the impact of high proportion of white blood cell (WBC) deduction therapy on comprehensive coagulation index and plasma fibrinogen concentration detected by continuous flow centrifuge (CFC) in blood component separator in patients with hyperleukocytic leukemia (HLL).Methods With ACD-A preservation solution as blood anticoagulant,the WBC deduction therapy was performed in patients with HLL by the mononuclear cell (MNC) program of the COBE Spectra type of CFC.In each cycle of treatment,2.5-3.0 times of total blood volume (TBV) was circulated,and the WBC suspension with 20 ％-25 ％ TBV was collected.56 times of WBC deduction treatment were performed in 39 patients with HLL.Results For a single treatment,(233.63±27.41) minutes was spent,(12 268.77±1 978.25) ml blood was circulated,(991.04±185.06) ml of ACD-A preservation solution was used,and (922.89±213.26) ml of WBC suspension were collected,in which WBC count was 551.05×109/L (396.76×109/L,756.45×109/L),the total number of WBC was 491.52×109 (341.53×109,754.51×109).Before treatment and after treatment,the WBC counts were 233.30× 109/L (163.62× 109/L,367.05 × 109/L) and 167.34× 109/L (94.40× 109/L,260.06× 109/L) (s =765,P＜ 0.001),PT were (15.69±2.82) s and (15.81±2.71) s (t =1.25,P＞ 0.05),aPTT were (39.22±8.15) s and (39.87±7.97) s (t =1.96,P ＞ 0.05),TT were (17.35±1.73) s and (17.48±1.57) s (t =1.77,P ＞ 0.05),Fbg concentration were (2.91±1.00) g/L and (2.61±0.81) g/L (t =7.49,P ＜ 0.001),respectively.Conclusions By high proportion(with 20 ％-25 ％ TBV) of WBC depletion therapy for patients with HLL,the WBC load was significantly reduced,as well as the concentration of plasma fibrinogen was deceased,too,while the reduction level of plasma fibrinogen concentration is in the compensatory range of body normal hemostatic function.There is no significant influence on comprehensive coagulation indexes (including PT,aPTF and TT) of endogenous and exogenous coagulation activity by WBC depletion therapy for patients with HLL.