培门冬酶在治疗儿童急性淋巴细胞白血病中的临床应用及其活性变化的意义

发布时间：2018-03-12 08:17

本文选题：培门冬酶　切入点：儿童　出处：《苏州大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探究培门冬酶(PEG-Asp)与左旋门冬酰胺酶(L-Asp)比较,在儿童急性淋巴细胞白血病(ALL)诱导化疗中的应用,以及PEG-Asp体外活性变化的意义。方法:回顾性分析本院2014年1月至2014年12月124例初诊ALL患儿,PEG-Asp组51例,L-Asp组73例,评价两组在诱导化疗中的不良反应及疗效。选取本院2015年6月至2015年12月间15例初诊ALL患儿,均在使用国产培门冬酶后D1、D15天监测PEG-Asp活性及底物浓度。结果:(1)入组患儿共124例,两组初诊患儿在过敏反应、肝功能异常、急性胰腺炎、血栓形成、关节疼痛、胃肠道反应等不良反应方面发生率相似,差异无统计学意义(P0.05)。(2)PEG-Asp组具有较高的凝血功能异常发生率和低蛋白血症发生率,与L-Asp组比,APTT、PT延长及FIB、AT-III降低发生率明显增高,差异有统计学意义(P0.05),两组APTT、PT均以1级障碍为主,FIB均以2、3级障碍为主。(3)PEG-Asp组51例,CR率90.2%,总有效率94.1%;L-Asp组73例,CR率91.8%,总有效率94.5%,两组差异无统计学意义(P龶0.929)。(4)诱导治疗中,D1天血清PEG-Asp活性均值为289.27±260.193IU/L,D15血清PEG-Asp活性均值为466.20±273.978IU/L(最低下限值为75 IU/L);D1、D15血清门冬酰胺(ASN)底物浓度低于最低下限值(150ng/ml)。结论:(1)PEG-Asp与L-Asp在儿童ALL诱导化疗中疗效无差异;(2)与L-Asp组相比,PEG-Asp组在凝血功能异常和低蛋白血症发生率较高;(3)监测PEG-Asp活性和底物浓度变化可作为评价其是否有治疗效价的依据。
[Abstract]:Objective: to explore the application of peg Aspp and L-Aspp in inducing chemotherapy in children with acute lymphoblastic leukemia (ALL). Methods: from January 2014 to December 2014, the changes of activity of PEG-Asp in vitro were analyzed retrospectively in 51 cases of PEG-Asp group and 73 cases of L-Asp group from January 2014 to December 2014. To evaluate the adverse reactions and efficacy of the two groups in induced chemotherapy, 15 patients with ALL were selected from June 2015 to December 2015. The activity of PEG-Asp and the concentration of substrate were monitored by D1C D15 days after the use of domestic aspartic enzyme. The incidence of allergic reaction, abnormal liver function, acute pancreatitis, thrombosis, joint pain and gastrointestinal reaction were similar between the two groups. There was no significant difference in the incidence of coagulation dysfunction and hypoproteinemia in the PEG-Asp group. Compared with the L-Asp group, the APTTT-PT prolonged and the FIBAT-III decreased significantly higher than that in the L-Asp group. The difference was statistically significant (P 0.05). The two groups of APTTT PT were mainly grade 1 disorder and FIB were mainly 2 or 3 grade disorder. The CR rate was 90.2 in 51 cases in PEG-Asp group, and the total effective rate was 91.8% in L-Asp group, and the total effective rate was 94.55.There was no significant difference between the two groups (P > 0.05). There was no significant difference between the two groups in the CR rate of 73 cases and the total effective rate of 91.8% in the L-Asp group. There was no significant difference between the two groups (P > 0.05). The mean value of serum PEG-Asp activity was 289.27 卤260.193 IUP / L on day 1 after induction therapy, and the mean value of serum PEG-Asp activity was 466.20 卤273.978 IUU / L (the lowest limit was 75 IUL / L ~ (1) D _ (1) D _ (15) serum asparagine) substrate concentration below the minimum limit of 150 ng / ml 路ml ~ (-1). Conclusion there is no effect of PEG-Asp and L-Asp in children with ALL induced chemotherapy. Compared with L-Asp group, PEG-Asp group had a higher incidence of coagulation dysfunction and hypoproteinemia. Monitoring the activity of PEG-Asp and the change of substrate concentration could be used as a basis for evaluating the therapeutic titer of PEG-Asp group.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R733.71

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