亚砷酸治疗中高危骨髓增生异常综合征患者的临床研究

发布时间：2018-06-03 02:09

本文选题：骨髓增生异常综合征 + 亚砷酸　；参考：《中国临床药理学杂志》2017年23期

【摘要】：目的观察亚砷酸联合阿糖胞苷(Ara-C)+阿克拉霉素(Acla)+粒细胞集落刺激因子(G-CSF)方案(CAG方案)治疗中、高危骨髓增生异常综合征(MDS)的临床疗效。方法接受治疗的中、高危骨髓增生异常综合征患者102例,随机分为对照组和试验组,每组51例。对照组患者给予CAG方案,阿糖胞苷10 mg·m~(-2)·d~(-1),皮下注射,q12 h,连续2周;阿克拉霉素20 mg·d-1,静脉滴注,连续1周;粒细胞集落刺激因子200μg·m~(-2)·d~(-1),皮下注射,q12 h,连续2周。试验组在对照组的基础上给予亚砷酸10 mg·d-1,静脉滴注,每周连续滴注5 d。2组均第3、4周休息,3个月为1个疗程,共治疗2个疗程。用流式细胞术检测2组患者治疗前后造血细胞凋亡情况,用Western blot法检测2组患者治疗前后凋亡相关蛋白B淋巴细胞瘤-2(Bcl-2)、Bcl-2相关的X蛋白(Bax)的表达水平,比较2组患者的临床疗效、长期疗效和药物不良反应发生情况。结果治疗后,试验组的总有效率为78.43%(40例/51例),对照组为60.78%(31例/51例,P0.05)。与治疗前相比,2组骨髓细胞凋亡率、Bax的表达水平均显著升高,而Bcl-2则显著下降;且试验组与对照组比较,差异有统计学意义(P0.05)。试验组患者1、2、3年累积生存率分别为84.31%(43例/51例),74.51%(38例/51例),60.78%(31例/51例),对照组分别为80.39%(41例/51例),64.71%(33例/51例),47.06.%(24例/51例),差异均有统计学意义(均P0.05)。对照组和试验组的药物不良反应主要以疲乏、嗜睡、轻度肾肝功能损伤、恶心呕吐为主,总药物不良反应发生率分别为47.06%(24例/51例)和41.18%(21例/51例),差异无统计学意义(P0.05)。结论亚砷酸联合CAG方案治疗中、高危骨髓增生异常综合征能有效诱导异常克隆细胞的凋亡,延长患者的生存期,药物不良反应较轻微,具有显著的临床疗效。
[Abstract]:Objective to observe the clinical effect of high risk myelodysplastic syndromes (MDS) treated by arsenite combined with Ara-Caclactinomycin Aclaa granulocyte colony-stimulating factor (G-CSF) regimen and CAG regimen. Methods 102 patients with high risk myelodysplastic syndrome were randomly divided into control group and trial group. Patients in the control group were given CAG regimen of 10 mg cytosine arabinoside (10 mg / d) DX for 12 h subcutaneously for 2 weeks, aclacinomycin 20 mg / d iv for 1 week, and granulocyte colony stimulating factor (200 渭 g / d) DX 1 for 2 weeks after subcutaneous injection of Q12 h. On the basis of the control group, the experimental group was given 10 mg / d arsenite intravenously. The rats in the control group were given 3 weeks rest for 4 weeks and 3 months as a course of treatment for 2 courses of treatment. The apoptosis of hematopoietic cells was detected by flow cytometry before and after treatment, and the expression of apoptosis associated protein B lymphocytoma (-2Bcl-2Bcl-2BX) was detected by Western blot method before and after treatment, and the clinical efficacy of the two groups was compared. Long-term efficacy and adverse drug reactions. Results after treatment, the total effective rate of the trial group was 78.43% and that of the control group was 60.78 cases / 51 cases respectively. Compared with the control group, the expression of Bax and Bax in bone marrow cells of the two groups were significantly increased, while the expression of Bcl-2 was significantly decreased, and the difference between the experimental group and the control group was statistically significant (P 0.05). In the trial group, the cumulative survival rates were 84.31% (43 / 51) and 60.7878 (31 / 51), respectively (P < 0.05). In the control group, the cumulative survival rates were 80.3939 / 41 / 41 / 41 / 41 / 41 / 33 / 51 / 47.06.51, respectively (P < 0.05). The main adverse drug reactions in the control group and the experimental group were fatigue, drowsiness, mild renal and liver function injury, nausea and vomiting. The incidence of total adverse drug reactions was 47.06% in 24 cases / 51 cases) and 41. 18% in 21 cases / 51 cases respectively. The difference was not statistically significant (P 0.05). Conclusion the high risk myelodysplastic syndromes can effectively induce the apoptosis of abnormal clone cells and prolong the survival time of patients with arsenite combined with CAG regimen.
【作者单位】：大理大学附属医院内科;
【基金】：国家医学教育发展中心医学研究课题基金资助项目(2010-24-03-068)
【分类号】：R551.3

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