沙利度胺配合化疗治疗急性白血病前后血浆VEGF，VEGFR和bFGF测定及意义

Significance and Monitoring of the Plasma Levels of VEGF,VEGFR and bFGF in Acute Leukemia Patients before and after Combined Treatment of Thalidomide and Chemotherapy

目的 探讨沙利度胺配合化疗治疗急性白血病的临床疗效及其对血管内皮生长因子（VEGF）、血管内皮生长因子受体（VEGFR）和碱性成纤维细胞生长因子（bFGF）水平的影响.方法 急性白血病患者44例,试验组和对照组各22例.每组均给以标准常规化疗方案治疗,试验组同时口服沙利度胺100 mg/d.治疗前及治疗后8周分别采集外周血,检测血浆VEGF,VEGFR和bFGF含量.同时以18例健康体检者为健康对照组.结果 试验组与对照组治疗有效率分别为86.4%和72.7%,差异有统计学意义（P〈0.05）.试验组与对照组治疗前血浆VEGF水平分别为389.92±249.74 pg/ml和328.74±135.77 pg/ml,高于健康组的133.91±27.63 pg/ml（P均〈0.01）;治疗后分别为210.75±35.81 pg/ml和289.03±32.76 pg/ml,高于健康组（P均〈0.05）;试验组与对照组治疗前VEGF差异无统计学意义（P〉0.05）,治疗后差异有统计学意义（P〈0.05）.试验组与对照组治疗前血浆VEGFR水平分别为2 496.75±1 796.90 pg/ml和2 372.80±1 205.87 pg/ml,高于健康组的1 136.38±369.45 pg/ml（P均〈0.01）;治疗后分别为1 369.71±381.25 pg/ml和1 764.88±347.02 pg/ml,与健康组相比差异有统计学意义（P均〈0.05）;试验组与对照组治疗前VEGFR差异无统计学意义（P〉0.05）,治疗后差异有统计学意义（P〈0.05）.试验组与对照组治疗前血浆bFGF水平分别为2.53±0.28 ng/ml和2.44±0.66ng/ml,均高于健康组的1.91±0.45 ng/ml（P〈0.05）;治疗后分别为2.17±0.18 ng/ml和2.12±0.40 ng/ml,与健康组相比差异有统计学意义（均P〈0.05）;试验组与对照组治疗前及治疗后相比差异均无统计学意义（P〉0.05）.结论 沙利度胺配合化疗可提高急性白血病患者的缓解率,有望成为一种通过抗血管新生从而抑制白血病细胞生长及浸润的有效治疗手段.

Objective To observe on the clinical effect and the influence of the level of plasma vascular endothelial growth fac- tor （VEGF）,vascular endothelial growth factor receptor （VEGFR） and basic fibroblast growth factor （bFGF） in acute leu- kemia before and after treatment by thalidomide combined with chemotherapy. Methods 44 cases of acute leukemia patients were randomly divided into experimental group and control group by 22 cases each. Each group was treated with convention- al chemotherapy in the standard-dose,meanwhile in the experimental group additional thalidomide 100mg/day were taken o- rally. Before treatment and 8 weeks after treatment,plasma were collected for the detection of VEGF, VEGFR and bFGF content by double antibody sandwich enzyme-linked immunosorbent assay. Results The ratio of experimental group and control group were 86.4% and 72. 7 % respectively and the difference was statistically significant （P〈0. 05）. The level of plasma VEGF （389.92±249.74 pg/ml,328. 74±135.77 pg/ml） of experimental group and control group before treatment was statistically significant （P〈0.01） compared with healthy group （ 133.91 ± 27.63 pg/ml） respectively. The level of plas- ma VEGF of those groups after treatment （210. 75 ± 35.81 pg/ml, 289.03 ± 32.76 pg/ml） was statistically significant （P〈 0. 05） compared with healthy group respectively. The difference of the level of plasma VEGF of experimental group and con- trol group before treantment was not statistically significant （P〈0.05）. The difference of the level of plasma VEGF of ex-perimental group and control group after treantment was statistically significant （P〈0.05）. The level of plasma VEGFR （2 496.75± 1 796.90 pg/ml,2 372.80±1 205.87 pg/ml） of experimental group and control group before treatment was statis- tically significant （P〈0. 01） compared with healthy group （1 136.38 ± 369.45 pg/ml） respectively. The level of plasma VEGFR of those groups after treatment （1 369. 71±381.25 pg/ml, 1 764. 88 ± 347.02 pg/ml） was statistically significant （P〈0.05） compared with healthy group respectively. The difference of the level of plasma VEGFR of experimental group and control group before treantment was not statistically significant （P〉0.05）. The difference of the level of plasma VEG- FR of experimental group and control group after treantment was statistically significant （P〈0. 05）. The level of plasma bFGF （2. 53±0. 28 ng/ml,2.44 ±0.66ng/ml） of experimental group and control group before treatment was statistically significant （P〈0. 05） compared with healthy group （1.91±0.45 ng/ml） respectively. The level of plasma bFGF of those groups after treatment （2.17 ± 0.18 ng/ml, 2.12 ± 0. 40 ng/ml） was statistically significant （P〈 0.05） compared with healthy group respectively. The differenee of the level of plasma bFGF of experimental group and control group before tre- antment was not statistically significant （P^0. 05）. The difference of the level of plasma bFGF of experimental group and control group after treantment was not statistically significant （P〈0.05）. Conclusion The remission rate could be im- proved by thalidomide combined with chemotherapy in acute leukemia, which could be an effective treatment by anti-angio- genesis and inhibiting the growth and infiltration of acute leukemia cells.