扶正祛邪中药联合含粒细胞集落刺激因子预激化疗方案治疗急性髓细胞白血病的疗效及安全性分析
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摘要
目的观察扶正祛邪中药联合含粒细胞集落刺激因子(G-CSF)预激化疗方案治疗急性髓细胞白血病(AML)的临床疗效及安全性。方法将74例AML患者按照随机数字表法分为2组。对照组37例予含G-CSF的预激化疗方案治疗;治疗组37例在对照组治疗基础上加用扶正祛邪中药治疗。2组均治疗2个月后统计疗效,比较2组治疗前后中医症状(包括乏力、发热、出血、口干及骨痛)评分及美国东部肿瘤协作组(ECOG)体能状态评分变化情况,比较2组治疗期间外周血中性粒细胞绝对值(ANC)<1.0×10~9/L的持续时间、血小板计数(PLT)<20×10~9/L的持续时间、红细胞悬液输注间隔时间及血小板悬液输注间隔时间,比较2组发生肺部感染、腹泻、恶心呕吐、发热及其他不良反应情况。结果治疗组总有效率89.19%,对照组总有效率37.84%,治疗组疗效优于对照组(P<0.05);2组治疗后临床症状乏力、发热、出血、口干及骨痛评分与本组治疗前比较均明显降低(P<0.05),且治疗后治疗组各临床症状评分均低于对照组(P<0.05);2组治疗后ECOG体能状态评分情况与本组治疗前比较均有明显改善(P<0.05),且治疗组治疗后ECOG体能状态评分改善情况优于对照组(P<0.05);治疗组治疗期间ANC<1.0×10~9/L持续时间及PLT<20×10~9/L持续时间均短于对照组(P<0.05),红细胞悬液输注间隔时间及血小板悬液输注间隔时间均长于对照组(P<0.05);治疗组发生肺部感染、腹泻、恶心呕吐、发热及其他不良反应情况少于对照组(P<0.05)。结论扶正祛邪中药联合含G-CSF预激化疗方案治疗AML可明显提高临床疗效,有效改善患者症状表现,促进ANC及PLT水平恢复,减少红细胞悬液及血小板悬液的应用,改善患者体能状态,减少不良反应发生,具有明显的减毒增效作用。
Objective To observe the clinical efficacy and safety of Fuzheng Quxie Chinese herbal combined with granulocyte colony-stimulating factor(G-CSF) pre-excitation chemotherapy in the treatment of acute myeloid leukemia(AML). Methods 74 AML patients were divided into two groups according to random number table method. 37 cases in control group were treated by pre-excitation chemotherapy containing G-CSF. The treatment group was treated by Fuzheng Quxie Chinese medicine on the basis of the control group. The curative effect was evaluated after 2 months of treatment in two groups. The changes of TCM symptom scores(including fatigue, fever, hemorrhage, dry mouth and bone pain) and physical condition scores of eastern American cancer collaboration group(ECOG) before and after treatment were compared. The duration of peripheral blood neutrophil absolute value(ANC) <1.0×10~9/L, platelet count(PLT)<20×10~9/L, interval of erythrocyte suspension infusion and interval of platelet suspension infusion were compared between the two groups. The incidence of pulmonary infection, diarrhea, nausea and vomiting, fever and other adverse reactions were compared between the two groups. Results The total effective rate was 89.19% in treatment group and 37.84% in control group. The curative effect of the treatment group was better than that of the control group(P<0.05). Compared with the group before treatment, the scores of TCM symptoms after treatment such as fatigue, fever, hemorrhage, dry mouth and bone pain in the two groups were significantly lower(P<0.05), and the scores of TCM symptoms in the treatment group were lower than those in the control group(P<0.05). Compared with the group before treatment, the ECOG physical condition score after treatment were significantly improved(P<0.05), and the improvement of ECOG physical condition score of the treatment group was better than that of the control group(P<0.05). The duration of ANC<1.0×10~9/L and PLT<20×10~9/L in the treatment group were shorter than those in the control group(P<0.05), the interval of erythrocyte suspension infusion and platelet suspension infusion were longer than those in the control group(P<0.05), and the incidence of pulmonary infection, diarrhea, nausea and vomiting, fever and other adverse reactions in the treatment group were less than those in the control group(P<0.05). Conclusion Fuzheng Quxie Chinese medicine combined with G-CSF pre-excitation chemotherapy regimen in the treatment of AML can significantly improve the clinical efficacy, effectively improve the symptoms of patients, promote the recovery of ANC and PLT levels, reduce the use of red blood cell suspension and platelet suspension, improve the physical condition of patients, reduce the occurrence of adverse reactions, and have a significant role in reducing toxicity and synergy.
Objective To observe the clinical efficacy and safety of Fuzheng Quxie Chinese herbal combined with granulocyte colony-stimulating factor(G-CSF) pre-excitation chemotherapy in the treatment of acute myeloid leukemia(AML). Methods 74 AML patients were divided into two groups according to random number table method. 37 cases in control group were treated by pre-excitation chemotherapy containing G-CSF. The treatment group was treated by Fuzheng Quxie Chinese medicine on the basis of the control group. The curative effect was evaluated after 2 months of treatment in two groups. The changes of TCM symptom scores(including fatigue, fever, hemorrhage, dry mouth and bone pain) and physical condition scores of eastern American cancer collaboration group(ECOG) before and after treatment were compared. The duration of peripheral blood neutrophil absolute value(ANC) <1.0×10~9/L, platelet count(PLT)<20×10~9/L, interval of erythrocyte suspension infusion and interval of platelet suspension infusion were compared between the two groups. The incidence of pulmonary infection, diarrhea, nausea and vomiting, fever and other adverse reactions were compared between the two groups. Results The total effective rate was 89.19% in treatment group and 37.84% in control group. The curative effect of the treatment group was better than that of the control group(P<0.05). Compared with the group before treatment, the scores of TCM symptoms after treatment such as fatigue, fever, hemorrhage, dry mouth and bone pain in the two groups were significantly lower(P<0.05), and the scores of TCM symptoms in the treatment group were lower than those in the control group(P<0.05). Compared with the group before treatment, the ECOG physical condition score after treatment were significantly improved(P<0.05), and the improvement of ECOG physical condition score of the treatment group was better than that of the control group(P<0.05). The duration of ANC<1.0×10~9/L and PLT<20×10~9/L in the treatment group were shorter than those in the control group(P<0.05), the interval of erythrocyte suspension infusion and platelet suspension infusion were longer than those in the control group(P<0.05), and the incidence of pulmonary infection, diarrhea, nausea and vomiting, fever and other adverse reactions in the treatment group were less than those in the control group(P<0.05). Conclusion Fuzheng Quxie Chinese medicine combined with G-CSF pre-excitation chemotherapy regimen in the treatment of AML can significantly improve the clinical efficacy, effectively improve the symptoms of patients, promote the recovery of ANC and PLT levels, reduce the use of red blood cell suspension and platelet suspension, improve the physical condition of patients, reduce the occurrence of adverse reactions, and have a significant role in reducing toxicity and synergy.
引文
[1] 李燕,王季石,袁钟,等.减低剂量的DA方案诱导治疗初治急性髓细胞白血病的临床疗效研究[J].贵州医药,2017,41(6):572-574.
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[14] 白艳玲,刘冰,孙惠英,等.化疗后中性粒细胞缺乏白血病患者医院感染的护理进展[J].护理学报,2011,18(17):27-30.
[15] 赵淑清,李军民.粒细胞集落刺激因子及其受体与血液相关疾病[J].中国实验血液学杂志,2015,23(3):871-877.
[16] 李玉峰,王春玲,丁帮和,等.高三尖杉酯碱治疗慢性粒细胞白血病的远期疗效观察[J].中华血液学杂志,2004,25(6):378-379.
[17] 李本尚,谢晓恬,廖雪莲,等.阿糖胞苷体外对人白血病细胞株HL-60细胞增殖抑制和诱导凋亡的相关性研究[J].中国小儿血液与肿瘤杂志,2004,9(3):103-107,111.
[18] 尹俊杰,梁波,王继芳,等.阿柔比星为基础的联合化学治疗方案治疗成人初治急性髓系白血病疗效观察[J].新乡医学院学报,2017,34(1):72-75.
[19] 马肖容,王瑾,张王刚,等.GHA及新型联合预激化疗方案治疗难治性急性髓系白血病和骨髓增生异常综合征的队列研究[J].中国实验血液学杂志,2015,23(2):369-374.
[20] 徐琪,张佳琦,柴铁,等.老年急性髓系白血病患者化疗后医院感染病原学、危险因素分析及预防[J].中国实用护理杂志,2010,26(14):50-52.
[21] 代喜平,李达,吴顺杰,等.中药联合化疗对老年急性髓系白血病生存期的影响[J].辽宁中医杂志,2008,35(6):873-874.
[22] 刘磊磊,陈娟,师彦平.清热解毒中药抗肿瘤作用研究进展[J].中草药,2012,43(6):1203-1212.
[23] 巨大维,魏品康.清热解毒中药在恶性肿瘤防治中的药用机理与应用[J].吉林中医药,2007,27(1):60-62.
[2] Kannan S,Sutphin RM,Hall MG,et al.Notch activation inhibits AML growth and survival:a potential therapeutic approach[J].J Exp Med,2013,210(2):321-337.
[3] 倪勋,邹兴立,谢坤莹,等.含G-CSF预激小剂量方案早期再诱导治疗急性髓系白血病的临床观察[J].重庆医学,2017,46(25):3500-3502.
[4] 刘加强,常鲁,刘志梅,等.CHG预激方案治疗老年AML疗效观察[J].山东医药,2008,48(4):95-96.
[5] 王珺,陈信义,董青,等.难治性急性白血病中西医诊疗研究进展[J].世界中医药,2013,8(8):979-984.
[6] 郝晶,孙凤,罗正凯,等.急性白血病中西医治疗进展[J].中医药信息,2013,30(4):137-139.
[7] 张之南,沈悌.血液病诊断及疗效标准[M].3版.北京:科学出版社,2007:106-115.
[8] 美国东部肿瘤协作组.体能状态评分ECOG评分法[J].中华普通外科学文献:电子版,2012,6(6):556.
[9] 郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:175.
[10] 王英俏.急性髓系白血病发病因素及慢性髓性白血病TKIs早期疗效评估的探讨[D].济南:山东大学,2016.
[11] Gao R,Das BB,Chatterjee R,et al.Epigenetic and genetic inactivation of tyrosyl-DNA-phosphodiesterase 1(TDP1)in human lung cancer cells from the NCI-60 panel[J].DNA Repair(Amst),2014,13:1-9.
[12] 张丽丽,吴建新.DNA甲基化——肿瘤产生的一种表观遗传学机制[J].遗传,2006,28(7):880-885.
[13] 胡荣,姜小鹰,许乐.老年急性白血病初治患者183例临床分析[J].中国老年学杂志,2010,30(19):2721-2723.
[14] 白艳玲,刘冰,孙惠英,等.化疗后中性粒细胞缺乏白血病患者医院感染的护理进展[J].护理学报,2011,18(17):27-30.
[15] 赵淑清,李军民.粒细胞集落刺激因子及其受体与血液相关疾病[J].中国实验血液学杂志,2015,23(3):871-877.
[16] 李玉峰,王春玲,丁帮和,等.高三尖杉酯碱治疗慢性粒细胞白血病的远期疗效观察[J].中华血液学杂志,2004,25(6):378-379.
[17] 李本尚,谢晓恬,廖雪莲,等.阿糖胞苷体外对人白血病细胞株HL-60细胞增殖抑制和诱导凋亡的相关性研究[J].中国小儿血液与肿瘤杂志,2004,9(3):103-107,111.
[18] 尹俊杰,梁波,王继芳,等.阿柔比星为基础的联合化学治疗方案治疗成人初治急性髓系白血病疗效观察[J].新乡医学院学报,2017,34(1):72-75.
[19] 马肖容,王瑾,张王刚,等.GHA及新型联合预激化疗方案治疗难治性急性髓系白血病和骨髓增生异常综合征的队列研究[J].中国实验血液学杂志,2015,23(2):369-374.
[20] 徐琪,张佳琦,柴铁,等.老年急性髓系白血病患者化疗后医院感染病原学、危险因素分析及预防[J].中国实用护理杂志,2010,26(14):50-52.
[21] 代喜平,李达,吴顺杰,等.中药联合化疗对老年急性髓系白血病生存期的影响[J].辽宁中医杂志,2008,35(6):873-874.
[22] 刘磊磊,陈娟,师彦平.清热解毒中药抗肿瘤作用研究进展[J].中草药,2012,43(6):1203-1212.
[23] 巨大维,魏品康.清热解毒中药在恶性肿瘤防治中的药用机理与应用[J].吉林中医药,2007,27(1):60-62.