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目的探讨直接抗凝血酶制剂—阿加曲班(商品名诺保思泰,Novastan)对急性早幼粒细胞白病(APL)合并弥散性血管内凝血(DIC)的疗效。方法初治和复发的 APL 合并 DIC 30例,随机分为低相对分子质量肝素钠治疗组(LM- WH 组)和阿加曲班治疗组(NOVAS 组)(对照为正常健康人群)。二组患者均给予我所的联合诱导(双诱导)缓解方案治疗,LMWH 组加用 LMWH,NOVAS 组加用 Novastan,观察二组患者临床出血情况、实验室 DIC 指标改善和完全缓解(CR)程度。结果 APL 合并 DIC 的二组患者治疗前后 PT、aPTT、Fbg 等值对比差异显著(P＜0.01)。LMWH 组与 NOVAS 组疗效比较差异显著(P＜0.05)。LMWH 组临床在血小板恢复方面有波动,其中1例患者并发脑出血死亡。NOVAS 组临床出血情况改善平稳,无相关并发症发生。结论阿加曲班治疗 APL 合并 DIC 疗效确切,无并发症,不依赖抗凝血酶(AT)的存在即可发挥抗凝血酶的作用,对 DIC 的高凝血期尤为适宜。
Objective To investigate the efficacy of direct antithrombin preparation - argatroban (Novazone, Novastan) in the treatment of acute promyelocytic leukemia (APL) combined with disseminated intravascular coagulation (DIC). Methods 30 newly diagnosed and relapsed APL patients with DIC were randomly divided into low molecular weight heparin sodium group (LM-WH group) and argatroban group (NOVAS group) (normal control group). Two groups of patients were given my co-induction (dual induction) remission program treatment, LMWH group plus LMWH, NOVAS group plus Novastan, observed two groups of patients with clinical bleeding, laboratory DIC index improvement and complete remission (CR) . Results There was significant difference in PT, aPTT and Fbg before and after treatment between two groups of patients with APL and DIC (P <0.01). There was significant difference between the LMWH group and NOVAS group (P <0.05). LMWH group clinically fluctuated platelet recovery, of which 1 patient died of intracerebral hemorrhage. The clinical bleeding in NOVAS group improved smoothly and no complication occurred. Conclusion Argatroban is effective in treating APL combined with DIC and has no complications. It can exert antithrombin independent of antithrombin (AT) and is especially suitable for high blood clotting period of DIC.