高三尖杉酯碱联合阿糖胞苷治疗骨髓增生异常综合征的疗效及安全性分析

Efficacy and Safety of Cytarabine Combined with Cytarabine in the Treatment of Myelodysplastic Syndrome

目的:探讨高三尖杉酯碱联合阿糖胞苷治疗骨髓增生异常综合征的疗效及安全性。方法:选择2015年1月-2019年1月在我院接受治疗的40例骨髓增生异常综合征患者,采用抽签法分为观察组(n=21)和对照组(n=19)。两组均给予地西他滨治疗,对照组在此基础上给予阿糖胞苷治疗,观察组在对照组的基础上给予高三尖杉酯碱治疗。比较两组患者的临床缓解情况、治疗前后血清内皮生长因子(VEGF)、骨髓中原始细胞占比、白细胞介素6(IL-6)、白细胞介素10(IL-10)、肿瘤坏死因子(TNF-α)水平、生存质量评分的变化及并发症的发生情况。结果:治疗后,两组总缓解率分别为71.43%,36.84%,观察组显著高于对照组(P<0.05);两组血清VEGF、骨髓中原始细胞占比水平均较治疗前显著降低,且观察组上述指标均明显低于对照组(P<0.05);两组血清IL-6、TNF-α水平均较治疗前显著降低,IL-10较治疗前显著升高,且观察组血清IL-6、TNF-α水平均显著低于对照组,IL-10水平明显高于对照组(P<0.05);两组生存质量评分水平均较治疗前显著降低,且观察组明显低于对照组(P<0.05);两组并发症总发生率为52.38%、84.21%,观察组显著低于对照组(P<0.05)。结论:高三尖杉酯碱联合阿糖胞苷治疗骨髓增生异常综合征的效果显著优于单用阿糖胞苷治疗,其可有效改善患者生存质量水平,且安全性更高,可能与其降低血清IL-6、TNF-α水平,升高IL-10水平,减轻炎症反应有关。

Objective:To study the efficacy and safety of cytarabine combined with cytarabine in the treatment of myelodysplastic syndrome.Methods:40 patients with myelodysplastic syndrome who were treated in our hospital from January 2015 to January 2019 were selected and randomly divided into the observation group(n=21)and the control group(n=19).Both groups were treated with descitabine,the control group was additionally treated with cytarabine,and the observation group was treated with trigeminine on the basis of control group.The clinical remission,changes of serum endothelial growth factor(VEGF),proportion of primary cells in bone marrow,interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor(TNF)-α,quality of life score before and after treatment and incidence of complications were compared between the two groups.Results:After treatment,the total remission rate of observation group and control group were 71.43%and 36.84%respectively,which was significantly higher in the observation group than that in the control group(P<0.05).The proportion of serum VEGF and primitive cells in bone marrow in both groups was significantly lower than that before treatment,and the above indexes in the observation group were significantly lower than those in the control group(P<0.05).The serum IL-6 and TNF-αlevels in both groups were significantly lower than those before treatment,which was significantly higher in the observation group.The serum IL-10 levels in the observation group were significantly higher than those in the control group,which was significantly higher in the observation group than those in the control group(P<0.05).The score of quality of life in both groups was significantly lower than that before treatment,which was significantly lower in the observation group than that of the control group(P<0.05).The total incidence of complications in the two groups was 52.38%and 84.21%,which was significantly lower in the observation group than in the control group(P<0.05).Conclusion:Monotherapy with cytarabine and trigeminine is more effective in the treatment of myelodysplastic syndrome than cytarabine alone,which can effectively improve the patients'quality of life with higher safety.The underlying mechanisms may be related to the decrease of serum IL-6 and TNF-αlevels and the increase of IL-10 levels.