血清G-CSF和IL-11与急性淋巴细胞白血病大剂量化疗感染和出血的关系分析
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摘要
目的:探讨血清粒系集落刺激因子(Granulocyte colony-stimulating factor,G-CSF)和白介素11(Interleukin 11,IL-11)与急性淋巴细胞白血病大剂量化疗感染和出血的关系。方法:选取2015年1月-2017年1月本院急性淋巴细胞白血病患者32例,患者均行大剂量甲氨蝶呤化疗,3个月为一疗程,共治疗3个疗程。比较患者治疗前后的血清G-CSF和IL-11水平,统计化疗期间和化疗后1个月内患者感染和出血情况,分析患者血清G-CSF和IL-11水平与其感染率和出血率的关系。结果:患者治疗后的血清G-CSF和IL-11水平均高于治疗前,比较差异均有统计学意义(P<0.05)。32例患者在化疗期间和化疗1个月内感染率为37.50%(12/32),出血率为50.00%(16/32)。未感染患者化疗前后的血清G-CSF和IL-11水平均高于感染患者(P<0.05);未出血患者化疗前后的血清G-CSF和IL-11水平均高于出血患者(P<0.05)。Spearman无条件相关分析结果显示,化疗后患者血清G-CSF与其感染率和出血率均呈负相关(r=-0.892、-0.815,P=0.000、0.002);化疗后IL-11水平与其感染率和出血率均呈负相关(r=-0.793、-0.762,P=0.013、0.018)。结论:急性淋巴细胞白血病大剂量化疗后患者血清G-CSF和IL-11水平与其感染和出血的发生密切相关,可作为其感染和出血评估的参考指标。
Objective:To investigate the relationship between serum granulocyte colony-stimulating factor(G-CSF)and interleukin 11(IL-11)and high-dose chemotherapy infection and hemorrhage in acute lymphoblastic leukemia.Method:A total of 32 patients with acute lymphoblastic leukemia in our hospital from January 2015 to January 2017 were selected,they were treated with high dose methotrexate chemotherapy,3months for every course and they were treated for 3 courses.The levels of serum G-CSF and IL-11 before and after treatment were compared,the infection and bleeding of patients during and after 1 month of chemotherapy were statistically analyzed,the relationship between the levels of serum G-CSF and IL-11 and the rate of infection and bleeding was analyzed.Result:The levels of serum G-CSF and IL-11 after treatment were higher than those of before treatment,the difference was statistically significant(P<0.05).In 32 patients,the infection rate was 37.50%(12/32)and the bleeding rate was 50.00%(16/32)during the chemotherapy and 1 month of chemotherapy.The levels of serum G-CSF and IL-11 in uninfected patients before and after chemotherapy were higher than those of infected patients(P<0.05),the levels of serum G-CSF and IL-11 in non bleeding patients before and after chemotherapy were higher than those of bleeding patients(P<0.05).Spearman unconditional correlation analysis showed that,after chemotherapy,there was a negative correlation between serum G-CSF and infection rate and bleeding rate(r=-0.892,-0.815,P=0.000,0.002),IL-11 was negatively correlated with infection rate and bleeding rate(r=-0.793,-0.762,P=0.013,0.018).Conclusion:The levels of serum G-CSF and IL-11 in patients with high-dose chemotherapy in acute lymphoblastic leukemia is closely related to the incidence of infection and bleeding,can be used as a reference index for the assessment of infection and bleeding.
Objective:To investigate the relationship between serum granulocyte colony-stimulating factor(G-CSF)and interleukin 11(IL-11)and high-dose chemotherapy infection and hemorrhage in acute lymphoblastic leukemia.Method:A total of 32 patients with acute lymphoblastic leukemia in our hospital from January 2015 to January 2017 were selected,they were treated with high dose methotrexate chemotherapy,3months for every course and they were treated for 3 courses.The levels of serum G-CSF and IL-11 before and after treatment were compared,the infection and bleeding of patients during and after 1 month of chemotherapy were statistically analyzed,the relationship between the levels of serum G-CSF and IL-11 and the rate of infection and bleeding was analyzed.Result:The levels of serum G-CSF and IL-11 after treatment were higher than those of before treatment,the difference was statistically significant(P<0.05).In 32 patients,the infection rate was 37.50%(12/32)and the bleeding rate was 50.00%(16/32)during the chemotherapy and 1 month of chemotherapy.The levels of serum G-CSF and IL-11 in uninfected patients before and after chemotherapy were higher than those of infected patients(P<0.05),the levels of serum G-CSF and IL-11 in non bleeding patients before and after chemotherapy were higher than those of bleeding patients(P<0.05).Spearman unconditional correlation analysis showed that,after chemotherapy,there was a negative correlation between serum G-CSF and infection rate and bleeding rate(r=-0.892,-0.815,P=0.000,0.002),IL-11 was negatively correlated with infection rate and bleeding rate(r=-0.793,-0.762,P=0.013,0.018).Conclusion:The levels of serum G-CSF and IL-11 in patients with high-dose chemotherapy in acute lymphoblastic leukemia is closely related to the incidence of infection and bleeding,can be used as a reference index for the assessment of infection and bleeding.
引文
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[5]徐雅靖,李晓林,赵谢兰,等.重组人血小板生成素与重组人白介素-11促进白血病患者异基因造血干细胞移植后血小板恢复的疗效比较[J].血栓与止血学,2013,19(4):145-149.
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[10]金香淑,杨岚,汪变红,等.急性淋巴细胞白血病中枢神经系统白血病21例临床特征与预后分析[J].中国实验血液学杂志,2016,24(6):1675-1682.
[11]赵红霞,孙万军,李洁,等.预防性G-CSF动员后供者淋巴细胞输注对高危白血病患者非清髓造血干细胞移植术后复发及移植物抗宿主病的影响[J].中华血液学杂志,2013,34(11):922-925.
[12]熊丹,李末娟.急性白血病化疗后并发败血症患者凝血功能异常与感染相关指标的关系及临床意义的分析[J].中国医学创新,2015,12(32):33-36.
[13]梁家宝,郭绪涛,黄芬,等.两种门冬酰胺酶治疗成人急性淋巴细胞白血病的疗效及安全性[J].第三军医大学学报,2016,38(7):737-742.
[14]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.
[15]杨培仙,吴陈新.重组人白细胞介素11联合自体血小板输注治疗急性白血病化学治疗相关性血小板减少40例[J].中国药业,2015,24(9):119-121.
[16]彭丽萍.微小残留病灶检测判断急性淋巴细胞白血病预后的临床研究[J].中国医学创新,2015,12(31):26-28.
[17]Liang J,Lei Z,Xu X,et al.Role of interleukin-6 in differentiating interleukin-11 induced fever and early bacterial infection[J].Indian J Pediatr,2014,81(9):871-875.
[18]何学鹏,杨凯,陈鹏,等.G-CSF诱导移植物抗白血病效应治疗异基因造血干细胞移植后复发白血病的临床研究[J].医学综述,2015,21(14):2656-2658.
[2]姬利云,赵瑞,张文林,等.IHDA方案再诱导治疗儿童难治性急性淋巴细胞白血病[J].中华实用儿科临床杂志,2016,31(9):696-699.
[3]朱剑锋,吴正东,吴德沛,等.CAG方案治疗难治、复发性急性淋巴细胞白血病的疗效观察[J].中华血液学杂志,2012,33(1):51-53.
[4]吴茗,马金香,李雪娴.粒细胞集落刺激因子降低急性白血病化疗后感染的效果评价[J].实用肿瘤杂志,2013,28(5):523-528.
[5]徐雅靖,李晓林,赵谢兰,等.重组人血小板生成素与重组人白介素-11促进白血病患者异基因造血干细胞移植后血小板恢复的疗效比较[J].血栓与止血学,2013,19(4):145-149.
[6]王凤云,孔凡良,蒋英俊,等.重组人白介素-11应用白血病化疗后血小板减少疗效观察[J].安徽医药,2015,19(9):1816-1817.
[7]张静,王建六.子宫内膜癌与细菌感染及炎症介质IL-6、IL-11的关系[J].中国妇产科临床杂志,2012,13(4):285-287.
[8]Bauhofer A,Lorenz W,Kohlert F,et al.Granulocyte colonystimulating factor prophylaxis improves survival and inflammation in a two-hit model of hemorrhage and sepsis[J].Crit Care Med,2006,34(3):778-784.
[9]张之南.血液病诊断与疗效标准[M].3版.北京:科学出版社,2007:131-134.
[10]金香淑,杨岚,汪变红,等.急性淋巴细胞白血病中枢神经系统白血病21例临床特征与预后分析[J].中国实验血液学杂志,2016,24(6):1675-1682.
[11]赵红霞,孙万军,李洁,等.预防性G-CSF动员后供者淋巴细胞输注对高危白血病患者非清髓造血干细胞移植术后复发及移植物抗宿主病的影响[J].中华血液学杂志,2013,34(11):922-925.
[12]熊丹,李末娟.急性白血病化疗后并发败血症患者凝血功能异常与感染相关指标的关系及临床意义的分析[J].中国医学创新,2015,12(32):33-36.
[13]梁家宝,郭绪涛,黄芬,等.两种门冬酰胺酶治疗成人急性淋巴细胞白血病的疗效及安全性[J].第三军医大学学报,2016,38(7):737-742.
[14]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.
[15]杨培仙,吴陈新.重组人白细胞介素11联合自体血小板输注治疗急性白血病化学治疗相关性血小板减少40例[J].中国药业,2015,24(9):119-121.
[16]彭丽萍.微小残留病灶检测判断急性淋巴细胞白血病预后的临床研究[J].中国医学创新,2015,12(31):26-28.
[17]Liang J,Lei Z,Xu X,et al.Role of interleukin-6 in differentiating interleukin-11 induced fever and early bacterial infection[J].Indian J Pediatr,2014,81(9):871-875.
[18]何学鹏,杨凯,陈鹏,等.G-CSF诱导移植物抗白血病效应治疗异基因造血干细胞移植后复发白血病的临床研究[J].医学综述,2015,21(14):2656-2658.