培门冬酶对急性淋巴细胞白血病患儿肝脏毒性的临床研究

The hepatotoxicity of polyethylene glycol conjugated L-asparaginase with therapeutic dose for acute lymphoblastic leukemia in childhood

目的观察治疗剂量的培门冬酶对急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患儿的肝脏毒性。方法观察本院儿科2012年10月至2014年7月使用培门冬酶化疗的48例ALL患儿肝损伤的临床表现,并动态监测患儿肝功能指标变化。结果 48例患儿中28例出现肝损伤,其中22例有临床表现,以消化道症状、肝肿大及黄疸为主;应用培门冬酶治疗前后,患儿肝功能指标γ-谷氨酰转肽酶(γ-GT)、总蛋白等无明显变化;谷丙转氨酶(ALT)水平第1周升高,第2周明显升高,第3周恢复正常;谷草转氨酶(AST)和总胆红素水平第2周轻度升高,清蛋白水平第2周轻中度下降,且均能于3周内恢复正常。结论培门冬酶治疗儿童ALL引起的肝损伤以消化道症状及肝脏肿大为主要临床表现,肝损伤程度较轻,经治疗一般均能恢复正常,但应动态监测肝功能指标变化。

Objective To study the hepatotoxicity of polyethylene glycol conjugated L-asparaginase（PEGAsp） with therapeutic dose in children with acute lymphoblastic leukemia（ALL）. Method A study of 48 ALL children in department of pediatrics of our hospital from October 2012 to July 2014 was performed, and their hepatotoxicity were monitored, included the observation of treatment response and dynamic changes in hepatic function. Result 28 cases of the 48 children had suffered liver function damage. Among them, 22 children with clinical manifestations, included digestive tract symptom, liver enlargement and jaundice. The liver function index serum γ-GT and total protein had no significant changes before and after treatment with PEG-Asp; ALT had elevated in the first week, and significantly increased in the second week, and in the third week, it returned to normal level; AST and total bilirubin appeared slightly increased in the second week, and albumin at the second week showed mild to moderate decline, and all of the laboratory indexes can recover to normal level within three weeks. Conclusion Digestive tract symptom are the main performance in the ALL children which suffered hepatic toxicity by PEG-Asp the hepatic dysfunction is gently and transient and usually reversible. But the dynamic changes should be observed closely.