DA方案联合参芪扶正注射液对急性髓系白血病的疗效及免疫状态的影响

Effects of DA regimen combined with Shenqi Fuzheng Injections on efficacy and immune status of acute myeloid leukemia

目的探讨DA方案(柔红霉素+阿糖胞苷)联合参芪扶正注射液对急性髓系白血病(AML)患者的疗效及免疫状态的影响。方法随机将74例AML患者均分为对照组和观察组,各37例,对照组给予DA方案治疗,观察组在对照组治疗的基础上联合参芪扶正注射液,观察2组临床疗效、治疗前及治疗21 d后血常规、T细胞亚群水平、血清生化指标[干扰素-γ(IFN-γ)、白细胞介素-10(IL-10)及白细胞介素-2(IL-2)水平]和药物不良反应。结果治疗后,组间临床缓解率及死亡率比较差异无统计学意义(P>0.05);2组白细胞(WBC)计数显著降低(P<0.05),血红蛋白(HGB)及血小板(PLT)计数显著提高(P<0.05),2组T细胞亚群中CD4+CD25+调节性T细胞(Treg)占比、Th17水平占CD4+比例显著降低(P<0.05),CD4+占比显著提高(P<0.05),2组血清IFN-γ及IL-2水平显著升高(P<0.05),IL-10水平显著降低(P<0.05),观察组变化幅度显著大于对照组(P<0.05);观察组治疗后的B淋巴细胞瘤-2基因(BCL-2)与程序性死亡受体-配体1信使核糖核酸(PD-L1 mRNA)表达水平显著低于对照组(P<0.05);观察组的恶心呕吐、多汗、出血、感染及心脏毒性发生率(分别为18.92%,5.41%,21.62%,24.32%和2.70%)显著低于对照组(分别为54.05%,24.32%,43.24%,48.55%和21.62%)(P<0.05)。结论参芪扶正注射液联合DA方案治疗AML患者可有效调节T细胞亚群水平,改善骨髓抑制情况,提高机体免疫功能,下调BCL-2与PD-L1 mRNA表达水平,可改善预后,且不良反应少。

Objective To explore the effects of DA regimen(daunorubicin+cytarabine)combined with Shenqi Fuzheng Injections on efficacy and immune status of patients with acute myeloid leukemia(AML).Methods 74 cases of AML patients were randomly divided into control group and observation group with 37 cases in each group.The control group were given DA regimen,and the observation group were given Shenqi Fuzheng Injections on the basis of treatment in control group.The clinical efficacy,blood routine,T cell subsets and serum biochemical markers[interferon-γ(IFN-γ),interleukin-10(IL-10),interleukin-2(IL-2)]before treatment and after 21 d of treatment and adverse drug reactions were observed and compared.Results After treatment,there was no statistically significant difference in clinical remission rate and mortality rate between the 2 groups(P>0.05).The white blood cell(WBC)count in the 2 groups was significantly decreased(P<0.05),while the hemoglobin(HGB)and platelet(PLT)count were significantly increased(P<0.05),and the proportions of CD4+CD25+Treg and Th17 in CD4+of T cell subsets in the 2 groups were decreased significantly(P<0.05),while the proportion of CD4+was increased significantly(P<0.05).The levels of serum IFN-γand IL-2 were increased significantly in the 2 groups(P<0.05),while the IL-10 level was significantly decreased(P<0.05),and the changes in observation group were significantly greater than those in control group(P<0.05).After treatment,the mRNA expression levels of B-Cell lymphoma-2(BCL-2)and programmed cell death-ligand1(PD-L1)in observation group were significantly lower than those in control group(P<0.05).The incidence rates of nausea and vomiting,sweating,bleeding,infection and cardiotoxicity in observation group were 18.92%,5.41%,21.62%,24.32%and 2.70%respectively,which were significantly lower than those in control group with 54.05%,24.32%,43.24%,48.55%and 21.62%respectively(P<0.05).Conclusion Shenqi Fuzheng Injections combined with DA regimen for AML patients can effectively regulate the levels of T cell subsets,improve the myelosuppression and body immune function,and down-regulate mRNA expression levels of BCL-2 and PD-L1,which can improve prognosis with less adverse reactions.