三氧化二砷维持治疗急性早幼粒细胞白血病对患者血脂代谢及远期生存率的影响

Effect of arsenic trioxide on blood lipid metabolism and long-term survival rate in patients with APL

目的探讨三氧化二砷维持治疗急性早幼粒细胞白血病(APL)对患者血脂代谢及远期生存率的影响,以期为寻找理想维持治疗方法提供依据。方法收集住院治疗,且经治疗完全缓解APL患者90例。随机单盲取法分为A、B、C组各30例,三组均给予三氧化二砷(ATO)联合全反式维甲酸(ATRA)治疗,完全缓解后A组给予ATO治疗,B组给予ATRA治疗,C组给予ATO与ATRA交替使用维持治疗。观察三组治疗前、完全缓解、维持治疗1周期、维持治疗2周期血清总胆固醇(TC)、甘油三脂(TG)变化及用药不良反应。维持治疗2疗程后所有患者均进行为期2年随访,观察三组患者生存及复发情况。结果三组治疗前及治疗后同期血脂同指标对比,差异无统计学意义;三组维持治疗2个周期各项血脂指标均低于同组治疗前、完全缓解、维持治疗1周期同指标(P<0.05)。三组患者治疗期间均有不良反应发生,A组与C组对比,各项不良反应发生率差异无统计学意义,B组颅压增高发生率高于C组(P<0.05),A组颅压增高发生率低于B组(P<0.05)。维持治疗后1年内三组生存率、复发率对比,差异无统计学意义;维持治疗后2年B组生存率低于C组(P<0.05);治疗后2年内三组复发率对比,差异无统计学意义。结论 ATO维持治疗APL对患者血脂影响、远期生存率及复发率影响较小,且不良反应发生率低下,疗效及不良反应发生率与ATO、ATRA交替维持相当,可作为维持治疗选择方案。

Objective To investigate the effect of arsenic trioxide on blood lipid metabolism and long-term survival rate in patients with acute early immature granulocyte（ APL）,in order to provide a basis for finding an ideal maintenance therapy. Methods Ninety APL patients with complete remission were enrolled in the study,who were assigned into group A,B and C using random single blind method. All three groups were treated with arsenic trioxide（ ATO） combined with all trans retinoic acid（ ATRA） in the treatment. After complete remission group A was treated with ATO therapy,group B ATRA therapy,and group C ATRA and ATO alternately for maintenance therapy. Observe the three groups before of Serum total cholesterol（ TC）,triglyceride（ TG） changes and adverse drug reactions in all three groups were observed before treatment,after complete remission,one cycle of maintenance treatment,and 2 cycles of maintenance treatment. After 2 courses of maintenance treatment,all patients were followed up for a period of 2 years and the survival and recurrence rate in the three groups were observed. Results There were no significant differences in blood lipids among all three groups before and after treatment respectively. In all three groups,the indexes of blood lipids after 2 cycles of maintenance treatment were all lower than those before treatment,after complete remission,and after 1 cycle of maintenance treatment（ P〈0.05）. There were adverse reactions in all three groups,with no significant difference in incidence of adverse reaction between group A and group C and a higher incidence of intracranial hypertension in group B than in group C（ P〈0.05）,and group A respectively（ P〈0.05）. One year after maintenance treatment,there were no significant differences in survival and recurrence rate among the three groups. Two years after maintenance treatment,a lower survival rate was found in group B than in group C（ P〈0.05）. There were no significant difference in recurrence rate among the three groups. Conclusions Maintenance treatment of APL with ATO had advantages of less impact on blood lipids,long-term survival rate and recurrence rate,fewer adverse reactions,and the same curative effect and incidence of adverse reactions as treatment with alternant ATO and ATRA,which can be used as maintenance treatment option.