回顾性分析应用粒细胞集落刺激因子支持治疗急性淋巴细胞白血病

A Retrospective Analysis on the Utilization of Granulocytes to Support the Treatment of Acute Lymphoblastic Leukemia

目的回顾性分析急性淋巴细胞白血病(ALL)患者在化疗后应用聚乙二醇化重组人粒细胞集落刺激因子(PEG-rhG-CSF)及重组人粒细胞集落刺激因子(rhG-CSF)的安全性及有效性。方法选取2014年11月-2015年11月某院血液科的118例ALL患者为研究对象,将其根据治疗方式的不同分为A组(PEG-rhG-CSF组)25例、B组(rhG-CSF组)57例和C组(PEG-rhG-CSF联合rhG-CSF组)36例。对比分析三组患者化疗后白细胞减少严重程度,开始G-CSF支持治疗时白细胞减少程度,G-CSF治疗所致不良反应发生情况以及药物注射次数。结果各分级白细胞减少患者,应用G-CSF治疗最终进展至Ⅳ级白细胞减少(或持续Ⅳ级白细胞减少超过5d)的发生率差异有统计学意义(P<0.01);组间进展情况比较,A组与B组中Ⅰ/Ⅱ级白细胞减少及Ⅲ/Ⅳ级白细胞减少者中,治疗后仍进展至Ⅳ级白细胞减少(或持续Ⅳ级白细胞减少超过5d)者比例差异均无统计学意义(P>0.05),而C组中该比例差异有统计学意义(P<0.01);3个治疗组最终进展至Ⅳ级白细胞减少的发生率差异无统计学差异(P>0.05)。各分级白细胞减少所致发热患者所占比例差异有统计学意义(P<0.01),其中15例Ⅳ级白细胞减少所致发热患者中有2例为感染性休克(B组和C组各1例);三组患者由于白细胞减少所致发热(不仅限于Ⅳ级白细胞减少时)所占比例差异无统计学意义(P>0.05)。所有患者中共出现G-CSF治疗相关的发热2例(B组及C组各1例),疼痛评分5级以上的骨痛3例(B组2例,C组1例),均给予口服镇痛药物后均可缓解。三组患者的注射次数比较,差异有统计学意义(P<0.01)。结论 PEG-rhG-CSF对于ALL化疗后白细胞减少的支持治疗较rhG-CSF更为安全、有效。对于ALL的化疗,推荐在Ⅰ/Ⅱ级白细胞减少时即开始使用G-CSF支持治疗,避免出现更严重的粒细胞缺乏及感染相关并发症。采用PEG-rhG-CSF治疗或联合应用两药治疗能在一定程度上减少注射次数,提高患者生活质量及减少护理工作量。

Objectives To analyze the safety and effectiveness of polyethylene glycol （PEG） after chemotherapy recombinant human granulocyte colony stimulating factor （PEG-rhG CSF） and recombinant human granulocyte colony stimulating factor （rhG CSF） of acute lymphoblastic leukemia （ALL） patients retrospectively. Methods 118 ALL patients of the hematology department of a hospital from November 2014 to November 2015 were selected as research objects, and divided into group A （PEG-rhG CSF group） 25 cases and group B （rhG CSF group） 57 cases and group C （PEG-rhG-joint rhG CSF-CSF group） 36 cases according to the different methods of treatment. A comparative analysis of the three groups was conducted to see the lower severity of white blood ceils after chemotherapy, at the beginning of the G-CSF support treatment, the adverse reactions caused by the G-CSF treatment and times of drug injections. Results The grading leukopenia patients used g-csf treatment eventually progress to level Ⅳ leukopenia （or continuous Ⅳ leukopenia more than 5 d） the incidence of difference was statistically significant （P〈 0. 01）. Progress comparison between groups, group A and group B Ⅰ levels/Ⅱ leukopenia and m/iV of leucopenia after treatment is still progress to Ⅳ leukopenia （or continuous Ⅳ leukopenia more than 5 d） the fraction differences had no statistical significance （P〉 0.05）, but the proportion in the group C difference was statistically significant （P〈0. 01）. Three treatment group eventually progress to IV white blood cells to reduce the incidence of difference no statistical difference （P〉 0. 05）. Each classification in patients with leucopenia caused by heating the percentage difference was statistically significant （P〈0. 01）, of which 15 cases IV level in patients with leucopenia caused by fever 2 for septic shock patients （group B and C groups （1 case）. Three groups of patients with leukopenia caused by fever （not only limited to grade IV leucocyte decrease） the percentage difference had no statistical significance （P〉0. 05）. All of the patients of the communist party of China with g-csf treatment related fever in 2 cases （group B and C groups （1 case）, pain score above magnitude 5 bone pain in 3 cases （group B in 2 cases, 1 case of group C）, were given after oral analgesic drugs can relieve. The differences were statistically significant （P〈 0. 01） in the three groups of patients. Conclusions PEG-rhG-CSF was safer and more effective than rhG-CSF for the reduction of white blood cells after ALL chemotherapy. For ALL of the chemotherapy, xecommended in Ⅰ / Ⅱ level leukopenia began using G-CSF support treatment, to avoid more serious granulocyte lack and infection related complications. A PEG-rhG-CSF treatment or combination of two drugs could reduce the number of injections, improve the quality of life and reduce the amount of care.