羟基脲联合干扰素α-2b序贯治疗真性红细胞增多症疗效观察

Observation of curative effect of hydroxyurea combined with interferon alpha-2b in the sequential treatment of polycythemia vera

目的观察羟基脲(HU)联合干扰素α-2b序贯治疗真性红细胞增多症的临床疗效及不良反应。方法对确诊为真性红细胞增多症(PV)的18例患者依据其意愿分为羟基脲联合干扰素α-2b(IFN-α-2b)序贯治疗组(A组)8例及单用羟基脲组(B组)10例,以治疗5个月为近期观察时限,观察两组红细胞(RBC)、血红蛋白(Hb)、红细胞压积(HCT)、白细胞(WBC)、血小板(PLT)以及脾脏大小等指标变化;以治疗2年以上为远期观察时限,比较两组远期疗效。结果两组患者治疗5个月后RBC、Hb、HCT、WBC、PLT以及脾脏大小等指标与治疗前相比均显著改善(P<0.01),但治疗后两组间上述指标比较差异无统计学意义(P>0.05)。A组2年内未发生复发病例,8例均持续完全缓解(CR),B组2年内持续缓解6例(其中CR 3例),HU减量过程中复发4例。两组远期疗效比较差异有统计学意义(P<0.05)。IFN的主要不良反应为流感样症状,经口服非甾体消炎药可控制,病人可耐受。结论羟基脲联合干扰素a-2b序贯治疗PV能使血细胞持续稳定在正常范围,安全性较好,值得基层医院推广。

Objective To investigate the curative effect and adverse reactions of hydroxyurea（HU） combined with inter- feron alpha-2b in the sequential treatment of polycythemia vera.Methods 18 patients confirmed with polycythemia vera （PV） were divided into group A （treated with interferon alpha-2 combined with hydroxyurea, 8 cases）and group B （only treated with hydroxyurea, 10 cases） according to their wishes. In the recent observation period limited to 5 months, indexes such as red blood cell count （ RBC）, hemoglobin （ Hb）, hematocrit （ HCT）, white blood cell count （ WBC ）, platelet count （PLT） and the size of spleen were observed.In the long-term observation period of more than two years ,the long-term curative effects of the two groups were compared.Results After five months of treatment, RBC, Hb, HCT, WBC, PLT and the size of spleen significantly improved （ P 〈0. 01 ）, but there were no significant differences in those above-mentioned indexes between groups （ P 〉0.05）.The long-term observation showed that there were no relapse cases in group A,and 8 cases got sustained complete remission（CR） within two years.6 cases in group B got sustained remission（ 3 cases got CR） and 4 cases relapsed during HU reduction process within two years.There was significant difference in long term efficacy between the two groups（ P 〈0. 05 ）. The main adverse reactions caused by interferon were flu-like symptoms, which could be controlled by oral NSAIDS,and could be tolerated by patients.Conclusion Hydroxyurea combined with interferon alpha-2b in the sequential treatment of PV is safe.They can keep the blood cells stable in the normal range.Thus, it is worth popularizing in primary hospitals.