不同化疗方案对初诊急性髓系白血病患儿预后及血小板的影响

Effects on prognosis and platelets of different chemotherapy regimens in children with acute myeloid leukemia

目的探讨不同化疗方案对初诊急性髓系白血病(AML)患儿预后及血小板的影响。方法采用随机数字表法将116例初诊AML患儿分为A组和B组,每组58例。A组患儿采用柔红霉素+阿糖胞苷+依托泊苷(DAE)方案化疗,B组患儿采用柔红霉素+阿糖胞苷(DA)方案化疗。比较两组患儿首次化疗前后的白细胞计数、血小板计数、血小板恢复时间以及首次化疗后异常染色体、骨髓完全缓解、复发情况。采用Logistic回归模型分析首次化疗后AML患儿预后的影响因素。结果首次化疗后,两组患儿的白细胞计数均明显低于本组化疗前,且A组患儿的白细胞计数明显低于B组,差异均有统计学意义(P﹤0.01)。首次化疗后,两组患儿的血小板计数均低于本组化疗前,且B组患儿的血小板计数低于A组,差异均有统计学意义(P﹤0.05)。A组患儿的血小板恢复时间明显短于B组,差异有统计学意义(P﹤0.01)。首次化疗后,A组患儿异常染色体发生率低于B组,骨髓完全缓解率高于B组,复发率低于B组,差异均有统计学意义(P﹤0.05)。Logistic回归分析结果显示,白细胞计数、DA方案均是AML患儿首次化疗后骨髓完全缓解的危险因素(P﹤0.01),血小板计数是首次化疗后AML患儿骨髓完全缓解的保护因素(P﹤0.01)。结论DAE方案和DA方案均能够改善AML患儿的预后情况,降低血小板水平,但DAE方案的疗效更佳,安全性更高。

Objective To investigate the effects on prognosis and platelets of different chemotherapy regimens in children with acute myeloid leukemia(AML).Method 116 children with AML were randomly divided into group A[n=58,treated with daunorubicin+cytarabine+etoposide(DAE)]and group B[n=58,treated with daunorubicin+cytarabine(DA)].The white blood cell count,platelet count,platelet recovery time before and after the first chemotherapy,as well as abnormal chromosomes,complete response and recurrence of bone marrow after the first chemotherapy were compared between the two groups.The factors influencing prognosis of AML after the first chemotherapy were analyzed by using Logistic regression model.Result The white blood cell count and platelet count after the first chemotherapy in the two groups were significantly reduced compared with that before chemotherapy,with significantly lower white blood cell count(P<0.01)and higher platelet count(P<0.05)in group A than that in group B.The platelet recovery time in group A was significantly shorter than that in group B(P<0.01).After the first chemotherapy,the incidence of abnormal chromosomes and recurrence of bone marrow in group A was significantly lower,and the complete response rate of bone marrow in group A was significantly higher than that in group B(P<0.05).Logistic analysis showed that white blood cell count and DA regimen were the risk factors affecting complete response of bone marrow after the first chemotherapy(P<0.05),and platelet count was a protective factor affecting complete response of bone marrow after the first chemotherapy(P<0.01).Conclusion DAE chemotherapy and DA chemotherapy can improve the prognosis of children with AML and reduce platelet levels,but DAE chemotherapy has better efficacy and safety.