摘要
目的探讨三氧化二砷对急性早幼粒细胞白血病(APL)患者血脂与血小板功能的影响。方法选取APL患者74例,采用随机数字表法分为对照组和试验组,各37例。两组患者均采用相同方案进行诱导和巩固治疗,对照组和试验组分别采用全反式维甲酸和三氧化二砷维持治疗,14 d为1个周期,两组均维持治疗2个周期。比较治疗期间两组患者外周血血脂代谢指标水平、治疗前后外周血血小板功能指标,统计两组不良反应情况。结果诱导治疗前至维持治疗2个周期,两组患者外周血TC、TG及LDL-C水平均逐渐升高,HDL-C水平逐渐降低(P <0. 05或P <0. 01);骨髓完全缓解后两组上述指标水平与诱导治疗前比较差异均无统计学意义(P> 0. 05);与诱导治疗前比较,试验组维持治疗1个周期TC、LDL-C和维持治疗2个周期TC、TG、LDL-C水平及对照组维持治疗1、2个周期TC、TG、LDL-C水平均明显升高,但试验组明显低于对照组(P <0. 05或P <0. 01);试验组维持治疗2个周期及对照组维持治疗1、2个周期HDL-C水平均明显降低,但试验组明显高于对照组(P <0. 05或P <0. 01)。与诱导治疗前比较,治疗结束后两组患者血小板聚集率均明显降低,且试验组明显低于对照组(P <0. 05或P <0. 01); PLT明显升高,且试验组明显高于对照组(P <0. 01);试验组血小板输注量及新鲜冰冻血浆输注量均明显小于对照组(P <0. 01)。试验组维甲酸综合征、颅内压增高发生率及总不良反应发生率均明显低于对照组(P <0. 05或P <0. 01)。结论随着治疗时间的延长,全反式维甲酸和三氧化二砷均可引起APL患者血脂代谢异常,但三氧化二砷对机体血脂代谢的影响小于全反式维甲酸;三氧化二砷可以抑制血小板聚集,改善血小板功能,降低不良反应发生率,安全有效。
Objective To investigate the effect of arsenic trioxide on blood lipid and platelet function in patients with acute promyelocytic leukemia（ APL）. Methods Totally 74 patients with APL were selected and divided into experiment group and control group according to the random number table method,37 cases in each group. The two groups were treated with the same regimen for induction and consolidation treatment,and control group and experiment group were treated with all-trans retinoic acid and arsenic trioxide for maintenance treatment respectively,14 d as a cycle for 2 cycles. The levels of blood lipid metabolism indexes of peripheral blood during treatment,platelet function indexes before and after treatment,and the adverse reactions of the two groups were compared. Results From induction treatment to maintenance treatment for 2 cycles,the levels of TC,TG,and LDL-C in the peripheral blood of the 2 groups gradually increased,and the HDL-C level gradually decreased（ P〈0. 05 or P〈0. 01）. After complete remission of bone marrow,the levels of the above indicators of the 2 groups had no significant changes compared with those before induction treatment（ P〈0. 05）. Compared with those before induction treatment,the levels of TC and LDL-C at one-cycle maintenance treatment and the levels of TC,TG,and LDL-C at two-cycle treatment in experiment group,and the levels of TC,TG and LDL-C in control group at one-and two-cycle maintenance treatment were significantly increased,but those in experiment group was significantly lower（ P〈0. 05 or P〈0. 01）; the level of HDL-C in experiment group at two-cycle maintrenance treatment and in control group at one-and two-cycle maintenance tratment was significantly decreased,but that in experiment group was significantly higher（ P〈0. 05 or P〈0. 01）. Compared with those before induction treatment,the platelet aggregation rate of the 2 groups after treatment was significant decreased,and that in experiment group was significantly lower（ P〈0. 05 or P〈0. 01）; the PLT was significantly increased,and the PLT in experiment group was significantly higher（ P〈0. 01）; the platelet transfusion volume and fresh frozen plasma transfusion volume in experiment group were significantly lower than those in control group（ P〈0. 01）. The incidence of retinoid syndrome,increased intracranial pressure and total adverse reactions in experiment group were significantly lower than those in control group（ P〈0. 05 or P〈0. 01）. Conclusion With the prolongation of treatment time,both all-trans retinoic acid and arsenic trioxide can cause abnormal lipid metabolism in APL patients,but arsenic trioxide has less effect on lipid metabolism than all-trans retinoic acid; arsenic trioxide can inhibit platelet aggregation,improve platelet function,and reduce the incidence of adverse reactions,which is safe and effective.
作者
高红秀
钟亚平
徐玉秀
王萍
王萌
任晓艳
马东升
GAO Hong-xiu;ZHONG Ya-ping;XU Yu-xiu;WANG Ping;WANG Meng;REN Xiao-yan;MA Dong-sheng(Department of Hematology,Central Hospital of Zhumadian,Zhumadian 463000,China)
出处
《实用药物与临床》
CAS
2018年第11期1229-1232,共4页
Practical Pharmacy and Clinical Remedies
