儿童急性淋巴细胞性白血病维持治疗期间巯嘌呤的减量及对远期预后的影响  

Reduction of 6-Mercaptopurinein in Children with Acute Lymphoblastic Leukemia during Maintenance Therapy and Its Effects on Long-Term Prognosis

作　　者：管玉洁[1] 韩金芬[2] 朱莹莹[1] 毛彦娜[1] 刘炜[1] Guan Yujie;Han Jinfen;Zhu Yingying;Mao Yanna;Liu Wei(Children’s Hospital Affiliated to Zhengzhou University,Henan Children’s Hospital,Zhengzhou Children’s Hospital,Henan Zhengzhou 450000,China;The Third Affiliated Hospital of Xinxiang Medical College,Henan Xinxiang 453000,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院,河南郑州450000 [2]新乡医学院第三附属医院,河南新乡453000

出　　处：《儿科药学杂志》2021年第3期10-14,共5页Journal of Pediatric Pharmacy

摘　　要：目的:探讨儿童急性淋巴细胞白血病(ALL)维持治疗中,依据外周血白细胞、中性粒细胞计数调低巯嘌呤(6-MP)用量或停药对远期预后的影响。方法:选取2011年1月至2016年1月郑州儿童医院收治的120例ALL患儿为研究对象,依据6-MP的用量将患儿分为标准剂量治疗组、半剂量及以上治疗组、半剂量以下治疗组及停药组,比较各组毒副作用发生率及全部疗程结束2年后各组的临床疗效。结果:除停药组患儿复发率增高之外(P<0.05),另三组患儿的无病生存率、复发率、病死率比较差异无统计学意义(P>0.05);依据白细胞及中性粒细胞计数调低或停用6-MP后,所有患儿皮疹、胃肠道反应、肝毒性、重症感染等毒副作用罕见发生。结论:依据患儿外周血白细胞及中性粒细胞计数调低6-MP用量不影响患儿的远期预后,临床无明显不良反应发生,但停药可增高患儿远期复发率。Objective:To probe into the reduction and withdrawal of 6-mercaptopurinein(6-MP)in children with acute lymphoblastic leukemia(ALL)during maintenance therapy and its effects on long-term prognosis.Methods:From Jan.2011 to Jan.2016,totally 120 children with ALL admitted into Zhengzhou Children’s Hospital were extracted to be divided into the standard dose treatment group,half dose and above treatment group,half dose and below treatment group and drug withdrawal group according to different doses of 6-MP.The incidence of side effects and clinical efficacy after treatment of two years were compared.Results:Except for the significant increase of recurrence rate in the drug withdrawal group(P<0.05),there was no significant difference in the disease-free survival rate,recurrence rate and mortality of the other three groups(P>0.05).After the reduction of white blood cells and withdrawal of 6-MP,all children had rare side effects such as rash,gastrointestinal reactions,hepatotoxicity and severe infection.Conclusion:According to the peripheral white blood cells and neutrophils count,the reduction of 6-MP does not affect the long-term prognosis of the children with ALL,and there are no significant clinical adverse drug reactions,but drug withdrawal can increase the long-term recurrence rate of the children.

关 键 词：急性淋巴细胞性白血病 儿童 巯嘌呤 预后 

分 类 号：R725.5[医药卫生—儿科]