摘要
目的 观察培门冬酶联合VDCP方案治疗急性淋巴细胞白血病(ALL)的效果及其对外周血可溶性跨膜蛋白(sFas)、血管内皮生长因子(VEGF)等的影响.方法 前瞻性选取2019年10月至2022年8月四川大学华西医院收治的80例ALL患者为对象,按照随机数字表法分为对照组(n=40)和观察组(n=40).对照组给予VDCP方案(长春新碱+依达比星+环磷酰胺+甲泼尼龙)治疗,观察组给予培门冬酶+VDCP方案治疗.比较两组总有效率,检测两组治疗前后sFas、VEGF、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、凝血功能指标[活化部分凝血酶时间(APTT)、血小板计数(PLT)、凝血酶原时间(PT)、D二聚体(D-D)、纤溶酶原激活抑制物-1(PAI-1)]、血常规[白细胞计数(WBC)、血小板计数(PLT)、红细胞计数(RBC)、血红蛋白]的差异,统计两组不良反应发生情况.结果 观察组总有效率为90.00％,高于对照组(72.50％),差异有统计学意义(P＜0.05).治疗后,两组血清sFas、VEGF、IL-8、TNF-α水平均较治疗前下降,且观察组的血清sFas、VEGF、IL-8、TNF-α水平分别为(4.03±1.06)pg/mL、(114.25±41.08)pg/mL、(12.14±2.05)pg/mL、(3.11±0.84)ng/L,均低于对照组[(5.89±1.41)pg/mL、(138.56±48.41)pg/mL、(15.98±3.23)pg/mL、(4.55±1.15)ng/L],差异均有统计学意义(P＜0.05).治疗后,两组PT、APTT较治疗前升高,Fib较治疗前下降,且观察组PT、APTT分别为(13.32±1.85)、(33.12±3.06)s,均高于对照组[(12.44±1.67)、(31.36±2.57)s],Fib 为(2.13±0.27)g/L,低于对照组[(2.54±0.32)g/L],差异均有统计学意义(P＜0.05);两组D-D、PAI-1治疗前后比较,差异均无统计学意义(P＞0.05).治疗后,两组WBC均较治疗前下降,PLT、RBC、血红蛋白均较治疗前升高,且观察组WBC为(5.88±1.23)×109/L,低于对照组[(8.59±1.54)×109/L],PLT、RBC、血红蛋白分别为(221.03±8.19)×109/L、(4.09±0.74)× 1012/L、(97.12±8.43)g/L,高于对照组[(215.63±9.44)× 109/L、(3.12±0.69)×1012/L、(82.69±9.22)g/L],差异均有统计学意义(P＜0.05).两组不良反应发生率比较,差异无统计学意义(P＞0.05).结论 VDCP方案联合培门冬酶治疗ALL可改善血常规,降低sFas、VEGF、IL-8、TNF-α的表达,不增加不良反应.
Abstract
Objective To observe the therapeutic effect of peraspartase combined with VDCP scheme on acute lymphoblastic leukemia(ALL)and its effect on peripheral blood soluble Fas(sFas)and vascular endothelial growth factor(VEGF).Methods Eighty patients with ALL admitted to West China Hospital of Sichuan University from October 2019 to August 2022 were prospectively selected as subjects and divided into the control group(n=40)and the observation group(n=40)according to the random number table method.The control group was treated with VDCP(vincristine+Edabicin+cyclophosphamide+methylprednisolone),and the observation group was treated with pemasonase+VDCP scheme.The total effective rate of the two groups was compared,and the differences of sFas,VEGF,interleukin-8(IL-8),tumor necrosis fac-tor-α(TNF-α),coagulation function indexes[activated partial thromboplastin time(APTT),platelet count(PLT),prothrombin time(PT),D-dimer(D-D),plasminogen activator inhibitor-1(PAI-1)]and blood routine[white blood cell count(WBC),platelet count(PLT),red blood cell count(RBC),hemoglobin]were detected between the two groups.The toxic and side effects of the two groups were analyzed.Results The total effective rate of the observation group was 90.00％,which was higher than that of the control group(72.50％),the difference was statistically significant(P＜0.05).After treatment,the levels of serum sFas,VEGF,IL-8,and TNF-α in two groups were lower than those before treatment,and the levels of serum sFas,VEGF,IL-8,and TNF-α in the observation group were(4.03±1.06)pg/mL,(114.25± 41.08)pg/mL,(12.14±2.05)pg/mL,and(3.11±0.84)ng/L,respectively,which were lower than those in the control group[(5.89 ±1.41)pg/mL,(138.56±48.41)pg/mL,(15.98±3.23)pg/mL,and(4.55±1.15)ng/L],the differences were statistically significant(P＜0.05).After treatment,PT and APTT in two groups were higher than those before treatment,while FIB were lower than those before treat-ment,the PT and APTT in the observation group were(13.32±1.85)and(33.12±3.06)s,respectively,which were higher than those in the control group[(12.44±1.67)and(31.36±2.57)s],FIB was(2.13±0.27)g/L,which was lower than that in the control group[(2.54 ±0.32)g/L],and the differences were statistically significant(P＜0.05).There were no statistically significant differences between the two groups of D-D and PAI-1 before and after treatment(P＞0.05);after treatment,PLT,RBC,and hemoglobin in two groups were higher than those before treatment,while WBC were lower than those before treatment,and WBC in the observation group was(5.88±1.23)× 109/L,which was lower than that in the control group[(8.59±1.54)×109/L],the PLT,RBC,and hemoglobin were(221.03±8.19)×109/L,(4.09± 0.74)×1012/L,(97.12±8.43)g/L,which were higher than those in the control group[(215.63±9.44)×109/L,(3.12±0.69)× 1012/L,(82.69±9.22)g/L],the differences were statistically significant(P＜0.05).There was no statistically significant difference in the inci-dence of adverse reactions between the two groups(P＞0.05).Conclusion In the treatment of ALL,peraspartase combined with VDCP scheme can improve blood routine,reduce the expressions of sFas,VEGF,IL-8 and TNF-α,and do not increase the toxic side effects.
基金项目
四川省卫生和计划生育委员会科研课题(19PJ121)
维普
万方数据