重组人白细胞介素11治疗急性白血病化疗后血小板减少的疗效和机制研究  

The efficacy and mechanism of rhIL-11 in the management of chemotherapy-induced thrombocytopenia in acute leukemia

作　　者：崔晓丽[1] 王琳[1] 高娟[1] 秦平[1] 石艳[1] 彭军[1] 侯明[1] 

机构地区：[1]山东大学齐鲁医院血液科,济南250012

出　　处：《中华血液学杂志》2005年第6期345-347,共3页Chinese Journal of Hematology

基　　金：国家自然科学基金资助项目(30300312;30470742)

摘　　要：目的观察重组人白细胞介素11(rhIL-11)治疗急性白血病(AL)患者化疗后血小板减少的疗效、安全性及其可能的机制。方法AL患者60例,其中32例在化疗结束后BPC≤30×109/L时用rhIL-11治疗,1.5mg/d皮下注射,连用7～14d或至血小板较用药前升高50×109/L以上时停药。观察rhIL-11的疗效及不良反应,ELISA法检测用药前血清IL11水平,RTPCR法检测单个核细胞IL-11受体α(IL11Rα)基因的表达,分析三者关系。以28例未用rhIL11治疗的患者作对照。结果①rhIL-11用药患者组(完全缓解26例,部分缓解2例,未缓解4例)用药后1周、2周血小板计数分别为(63.40±7.24)×109/L、(98.70±9.37)×109/L;对照组(完全缓解20例,部分缓解3例,未缓解5例)为(42.50±6.38)×109/L、(70.30±7.12)×109/L;rhIL11用药患者组较对照组血小板恢复时间缩短(P<0.05)。rhIL11用药患者组10例需要输注血小板,平均为16～32U;对照组19例,平均为32～48U。常见不良反应为轻度乏力、肌肉疼痛,5例出现短暂房性心律失常,减量或停药后消失。显效组用药前平均IL11水平为(21.81±1.88)ng/L,低于无效组(35.75±2.10)ng/L(P<0.05);其IL-11Rα相对水平为0.3552±0.0224,高于无效组(0.1692±0.0066)(P<0.05)。用药前血清IL-11、单个核细胞IL-11Rα水平与血小板计数均无相关性;用药后IL-11水平与骨髓巨核细胞计数无相关性。结论rhI-11治疗AL患者化疗后引起的血小板减少安全有效;检测用药前血清IL-11水平和单个核细胞IL-11Rα的表达对预测rhIL-11疗效有一定意义。Objective To investigate the efficacy, safety and possible mechanism of rhIL-11 in the management of chemotherapy-induced thrombocytopenia in acute leukemia. Methods Thirty-two acute leukemia patients were enrolled in the study. rhIL-11 was given when platelet count dropped below 30×10~ 9/L after chemotherapy,at 1.5 mg/d, ih, for 7-14 days or withdrawn when the increase of platelet count was more than 50×10~ 9/L. Serum IL-11 level was determined by ELISA, IL-11R α gene expression by RT-PCR. Efficacy and safety data were collected and their correlation with serum IL-11 and IL-11Rα expression were analyzed. Results The platelet counts on day 7 and 14 after medication were (63.40±7.24)×10~ 9/L and (98.70±9.37)×10~ 9/L for 32 patients in IL-11 group \[26 complete remission (CR),2 partial remission (PR),4 non-remission (NR)\] and (42.50±6.38)×10~ 9/L and (70.30±7.12)×10~ 9/L for the control group (20 CR, 3 PR, 5 NR). There were 10 patients who received platelet transfusion (16-32 U) in IL-11 group and 19 patients (32-48 U) in control group. Compared with the IL-11 group a delay of platelet recovery was observed in controls (P<0.05). IL-11 was generally well tolerated. Five experienced transient atrial arrhythmia and relieved after extenuation or withdrawal. The responders’ serum IL-11 level of pre-medication was (21.81±1.88)ng/L, lower than that of non-responders(P<0.05). IL-11Rα level was 0.3552± 0.0224, higher than that of non-responders (P<0.05). No correlation was observed among serum IL-11, IL-11Rα expression, platelet count, and megakaryocyte number. Conclusions rhIL-11 can safely accelerate the recovery of chemotherapy-induced thrombocytopenia in acute leukemia.The serum IL-11 level and IL-11Rα of mononuclear cells might predict the efficacy of rhIL-11.

关 键 词：重组人白细胞介素11 治疗 急性白血病 化疗 血小板减少 疗效观察 

分 类 号：R733.71[医药卫生—肿瘤] R558.2[医药卫生—临床医学]