【摘要】：目的觀察重組人血小板生成素(rh TPO)治療急性白血病化療后血小板減少的臨床療效。方法對(duì)125例于青島大學(xué)附屬醫(yī)院血液內(nèi)科住院的急性白血病化療后血小板減少的患者,進(jìn)行回顧性分析研究。其中男性65例,女性60例。按疾病類型來分,急性髓系白血病87例,急性淋巴細(xì)胞白血病38例。其中在急性髓系白血病中,急性髓細(xì)胞白血病微分化型(M0)1例,急性粒細(xì)胞白血病未分化型(M1)10例,急性粒細(xì)胞白血病部分分化型(M2)20例,急性早幼粒細(xì)胞白血病(APL)10例,急性粒-單核細(xì)胞白血病(M4)23例,急性單核細(xì)胞白血病(M5)22例,紅白血病(M6)1例。入院后評(píng)估患者無化療禁忌后,立即給予化療�；熕幬镏幸暂飙h(huán)類及蒽醌類為基礎(chǔ)藥物,并聯(lián)合阿糖胞苷�；煼桨钢屑毙运柘蛋籽≈饕獮镈A方案(阿糖胞苷+柔紅霉素)、IDA方案(阿糖胞苷+去甲氧柔紅霉素)、TA方案(吡喃阿霉素+阿糖胞苷)、MA方案(米托蒽醌+阿糖胞苷)、EA方案(依托泊苷+阿糖胞苷)、HA方案(高三尖杉酯+阿糖胞苷)等為主。急性淋巴細(xì)胞白血病主要為VP(長(zhǎng)春新堿+潑尼松)、VDP(長(zhǎng)春新堿+潑尼松+柔紅霉素)及VDCLP方案(長(zhǎng)春新堿+地塞米松、潑尼松+柔紅霉素+環(huán)磷酰胺+左旋門冬酰胺酶)等化療方案進(jìn)行。急性白血病化療后進(jìn)入骨髓抑制期,骨髓抑制引起巨核細(xì)胞系增生減低,進(jìn)而引起血小板減少。不同化療階段及強(qiáng)度引發(fā)骨髓抑制不同,引起的血小板減少的持續(xù)時(shí)間也不同。隨后將125例急性白血病化療后血小板減少患者按治療階段分為誘導(dǎo)緩解治療組、鞏固治療組、強(qiáng)化治療組,后再分別分為實(shí)驗(yàn)組和對(duì)照組,當(dāng)血小板計(jì)數(shù)≤30×109/L時(shí),給予實(shí)驗(yàn)組皮下注射重組人血小板生成素15 000 U,給予對(duì)照組皮下注射重組人白介素-11(rh IL-11),用藥時(shí)間為7-14天,用藥時(shí)間到達(dá)14天或當(dāng)血小板計(jì)數(shù)上升至5 0×109/L,停藥;有出血傾向或血小板計(jì)數(shù)20×109/L時(shí),給予應(yīng)用止血藥物預(yù)防出血或止血。必要時(shí)給予輸注去白細(xì)胞單采血小板1治療量。比較各組患者在年齡、性別、疾病類型等方面無明顯差異后,觀察并記錄三個(gè)治療階段的實(shí)驗(yàn)組和對(duì)照組血小板計(jì)數(shù)50×109/L的持續(xù)時(shí)間、恢復(fù)到70×109/L和100×109/L的時(shí)間,并觀察實(shí)驗(yàn)組和對(duì)照組輸血次數(shù)及不良反應(yīng)發(fā)生率。并運(yùn)用合適的統(tǒng)計(jì)學(xué)方法分析數(shù)據(jù)。結(jié)果誘導(dǎo)緩解治療組、鞏固治療組、強(qiáng)化治療組的實(shí)驗(yàn)組血小板計(jì)數(shù)50×109/L的持續(xù)時(shí)間、恢復(fù)到70×109/L和100×109/L的時(shí)間顯著低于對(duì)照組(P0.05);實(shí)驗(yàn)組輸注血小板次數(shù)顯著少于對(duì)照組(P0.05)。實(shí)驗(yàn)組的不良反應(yīng)出現(xiàn)率顯著低于對(duì)照組(3.2%15.6%)(P0.05)。結(jié)論重組人血小板生成素(rh TPO)用于治療急性白血病化療后血小板減少的療效好,不良反應(yīng)少。
[Abstract]:Objective to observe the clinical effect of recombinant human thrombopoietin (rh TPO) on thrombocytopenia after chemotherapy in acute leukemia. Methods 125 patients with thrombocytopenia after chemotherapy in Department of Hematology, affiliated Hospital of Qingdao University were studied retrospectively. There were 65 males and 60 females. According to the type of disease, 87 cases of acute myeloid leukemia and 38 cases of acute lymphoblastic leukemia. Among them, 1 case of acute myeloid leukemia (M0), 10 cases of acute myeloid leukemia (M1), 20 cases of partial differentiation (M2) of acute myeloid leukemia (AML), and 1 case of M0, 10 cases of undifferentiated type of acute myeloid leukemia (M1), 20 cases of partial differentiation of acute myeloid leukemia (M2). There were 10 cases of acute promyelocytic leukemia (APL), 23 cases of acute myelo-monocytic leukemia (M4), 22 cases of acute monocytic leukemia (M5) and 1 case of erythroleukemia (M6). After admission, the patients were given chemotherapy immediately after no contraindication of chemotherapy. Anthracyclines and anthraquinones are the basic drugs in chemotherapeutic drugs, combined with cytarabine. In the chemotherapy regimen, acute myeloid leukemia was mainly DA regimen (cytarabine daunorubicin), IDA regimen (cytarabine normodaunorubicin), TA regimen). MA regimen (mitoxantrone cytarabine), EA regimen (etoposide cytarabine), HA regimen), etc. VP (vincristine prednisone), VDP () and VDCLP regimen (vincristine dexamethasone) were the main types of acute lymphoblastic leukemia. Prednisone daunorubicin cyclophosphamide (L-asparaginase) and other chemotherapy regimen. After chemotherapy, acute leukemia enters the stage of bone marrow suppression, which leads to the decrease of megakaryocyte cell line proliferation, and then to thrombocytopenia. The duration of thrombocytopenia was different in different stages and intensity of chemotherapy. Then 125 patients with thrombocytopenia after chemotherapy in acute leukemia were divided into three groups: induction remission group, consolidation treatment group, intensive treatment group, and then divided into experimental group and control group respectively. When platelet count was 鈮，

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