三氧化二砷注射液对人体的不良反应分级及其防治对策  

Adverse effects of intravenous arsenic trioxide and their prevention

作　　者：吴楠[1] 胡龙虎[2] 周晋[2] 范圣瑾[2] 王艳[2] 韩雪英[2] 

机构地区：[1]广州市第十二人民医院血液内科,510620 [2]哈尔滨医科大学第一临床医学院血液内科

出　　处：《中华内科杂志》2006年第4期310-313,共4页Chinese Journal of Internal Medicine

摘　　要：目的三氧化二砷(As2O3)注射液治疗急性早幼粒细胞白血病的不良反应进行分级,提出防治对策。方法观察治疗前后体重、皮肤、神经、消化、呼吸、心血管、血液及泌尿等系统变化,用原子吸收光谱法测定血、尿及发砷含量。结果砷吸收者38.67%(99/256),观察其临床反应;轻度不良反应57.43%(147/256),未停砷剂,对症治疗,短期恢复;慢性轻度中毒2.73%(7/256),以多肢体砷斑、肝功能异常及周围神经损害为特征,停As2O3、保肝治疗,逐渐恢复;慢性中度中毒1.17%,表现为重症肝病,均死于肝功能衰竭。诱导缓解治疗后38.89%外周血WBC升高,As2O3停用或减量、小剂量化疗及WBC单采。缓解期治疗后51.35%的WBC减低,未停砷剂,未用升白药物,逐渐恢复。用药后24h血砷浓度稍高于治疗前,但又明显低于治疗后6h,说明血浆中As2O3分布及排出较迅速,无血浆蓄积性。用药后24h尿砷浓度明显高于治疗前,提示尿为砷剂的主要排泄方式之一。停药后50d发砷含量仍明显高于治疗前,说明As2O3在毛发中有一定的蓄积性。结论治疗剂量As2O3不良反应多为轻度的,可逆性的,无需停As2O3,对症可缓解。少数病人,特别是合并肝炎的病人可出现慢性中毒。As2O3能使诱导缓解的病人WBC升高,应及早防治。Objective To study the main side effects of As2O3 and the way of prevention. Methods The changes of body weight and various systems of body were observed after treatment with As2O3 injection. The arsenic content in blood, urine and hair was detected with atom absorbed-spectrum analysis. Results Mild reactions were observed in 57.43% （147/256） of the patients and they could subside after ccasation of arsenic treatment or ailotherapy . Chronic mild poisoning manifestations including arsenic furuncle, liver dysfunction and peripheral nerve injury were found in 2. 73% （7/256） of the patients and they subsided gradually after treatment. Chronic severe poisoning was found in 1.17% of the patients and all of them died of liver failure. As2O3 might cause decrease of peripheral blood WBC in eatabatie patients. There was no infection after allopathy without ceasing arsenic medication. The results showed that As2O3 could distribute over and discharge from the plasma without accumulation in blood. The results also demonstrated the main route of excretion for As2O3 is through urine and there is definite accumulation in the hair 50 days after treatment. Conclusion Most of the side effects of As203 are mild and reconverable. Allotherapy could be effective to relieve the complications without stopping arsenic medication. A few patients with complicating hepatitis may suffer from chronic poisoning. As2O3 may cause increase of peripheral blood WBC in induced catabatic APL patients. The side effects must be prevented early.

关 键 词：砷剂 白血病 早幼粒细胞 急性 药物毒性 

分 类 号：R595.3[医药卫生—内科学]