阿扎胞苷联合CAG方案治疗老年急性髓系白血病的疗效、不良反应及血液学指标变化观察

Observation on the effect,side effects and hematological indexes changes of azacitidine combined with CAG regimen in the treatment of the elderly with acute myeloid leukemia

目的观察阿扎胞苷联合CAG方案(阿柔比星、阿糖胞苷和粒细胞集落刺激因子)治疗老年急性髓系白血病(AML)的疗效、不良反应及血液学指标变化。方法前瞻性选取将2016年1月至2019年12月四川绵阳四0四医院收治84例AML患者作为研究对象,采用随机数字表法将其分为观察组及对照组,每组42例。对照组给予CAG方案治疗,观察组在此基础上给予阿扎胞苷联合治疗,均治疗1个疗程。比较2组患者治疗疗效、治疗期间不良反应发生率及中性粒细胞恢复时间、血小板恢复时间、血小板输注量;观察2组患者治疗前、治疗1个疗程后血液学指标及免疫功能指标变化情况,并统计2组患者术后1年生存情况。结果观察组治疗总有效率(83.33%)高于对照组(61.90%),差异有统计学意义(P<0.05)。观察组中性粒细胞恢复时间及血小板恢复时间短于对照组(P<0.05),2组血小板输注量对比差异无统计学意义(P>0.05)。观察组治疗后白细胞计数及血小板计数大于对照组,血红蛋白水平低于对照组(P<0.05);观察组治疗后CD3^(+)、CD4^(+)、CD8^(+)值小于对照组(P<0.05);2组治疗后CD4^(+)/CD8^(+)值对比差异无统计学意义(P>0.05),观察组术后1年生存率高于对照组(P<0.05);2组不良反应发生率对比差异无统计学意义(P>0.05)。结论阿扎胞苷联合CAG方案治疗老年AML的临床疗效较高,能改善血液学指标,并能提高1年生存率,但对免疫功能的影响不大。

Objective To observe the effect,side effects and hematological indexes changes of azacitidine combined with CAG regimen(Arubicin,Cytarabine and Granulocyte Colony Stimulating Factor)in the treatment of the elderly with acute myeloid leukemia(AML).Methods A total of 84 elderly AML patients who admitted to Sichuan Mianyang 404 Hospital from January 2016 to December 2019 were prospectively selected as the research objects and divided into observation group and control group by random number table method,42 cases in each group.The control group was treated with CAG regimen,while observation group was treated with azacitidine on this basis.Both groups were treated for 1 course.The curative effect,incidence of side effects during treatment,recovery time of neutrophils and platelets,and platelet transfusion volume were compared between the two groups.The changes in hematological indexes and immune function indexes before and after treatment in both groups were observed.The survival situations at 1 year after surgery in both groups were statistically analyzed.Results The total response rate of treatment in observation group was higher than that in control group(P<0.05),recovery time of neutrophils and platelets was shorter than that in control group(P<0.05).There was no significant difference in platelet transfusion volume between the two groups(P>0.05).After treatment,white blood cell count and platelet count in observation group were higher than those in control group,while hemoglobin level was lower than that in control group(P<0.05).After treatment,CD3^(+),CD4^(+) and CD8^(+) in observation group were lower than those in control group(P<0.05).There was no significant difference in CD4^(+)/CD8^(+) between the two groups(P>0.05).The survival rate at 1 year after surgery in observation group was higher than that in control group(P<0.05).There was no significant difference in the incidence of side effects between the two groups(P>0.05).Conclusion The clinical curative effect of azacitidine combined with CAG is relatively higher on elderly AML.It can improve hematological indexes and 1-year survival rate,with few effects on immune function.