减低剂量阿扎胞苷治疗老年骨髓增生异常综合征的疗效及安全性分析  

Efficacy and Safety of Reduced Dose Azacitidine in the Treatment of Elderly Patients with Myelodysplastic Syndromes

作　　者：张聪 孙财 汪德珍 刘占为[1] 房婷 ZHANG Cong;SUN Cai;WANG De-Zhen;LIU Zhan-Wei;FANG Ting(Dqarment of Homarology,Hluaibei Muners Goncral Hapital,Huaibei 235000,Anhui Province,China;Depurmuent of Homuaology,The AfTiated Hospital of Xuchou Medical Unieriy,Xushou 221002,Jiangou Province,China;Depurtment of Special Operatioms Medicine,The 960th Hospital of the PLA Joint Logistics Support Force,Jinan 250031,Shandong Province,China)

机构地区：[1]淮北矿工总医院血液内科,安徽淮北235000 [2]徐州医科大学附属医院血液内科,江苏徐州221002 [3]中国人民解放军联勤保障部队第九○六医院特勤科,山东济南250031

出　　处：《中国实验血液学杂志》2024年第4期1160-1164,共5页Journal of Experimental Hematology

基　　金：淮北市科技局课题(2021HK028);国家自然科学基金:(82200225)。

摘　　要：目的:分析减低剂量阿扎胞苷治疗老年骨髓增生异常综合征(MDS)的疗效和安全性。方法:选取2018年1月至2022年6月于安徽省淮北矿工总医院血液内科及徐州医科大学附属医院血液内科初次诊断的92例老年MDS患者,并随机分为观察组和对照组(各46例患者)。观察组采用减低剂量阿扎胞苷100 mg/d,d1-7,以28 d为1个疗程,共用6个疗程;对照组采用标准剂量阿扎胞苷75 mg/(m^(2)·d),d1-7,以28 d为1个疗程,共用6个疗程。观察两组患者的临床疗效、总生存期及不良事件发生率。结果:两组患者临床资料差异均无统计学意义(P>0.05)。治疗后,两组患者血红蛋白和血小板水平较各组治疗前均显著升高(P<0.05)。观察组和对照组患者之间的白细胞、血红蛋白和血小板水平对比,差异均无显著统计学意义(P>0.05)。观察组完全缓解、部分缓解、血液学缓解、疾病稳定和疾病进展病例数分别为4、10、22、6和4例,总有效率为78.26%;对照组完全缓解、部分缓解、血液学缓解、疾病稳定和疾病进展病例数分别为8、12、18、4和4例,总有效率为82.61%。观察组患者总有效率略低于对照组,但差异无统计学意义(χ^(2)=0.457,P=0.254)。两种治疗方案对是否有输血依赖和低危、中危及高危组患者的疗效无显著性统计学差异(P>0.05)。对照组和观察组达到最佳治疗反应分别需要4个和6个疗程,且两组患者总生存期无显著差别(P>0.05)。观察组出现感染、Ⅲ-Ⅳ°骨髓抑制、胃肠道反应的病例数分别有4、6和2例,不良事件发生率为26.09%;对照组出现感染、Ⅲ-Ⅳ°骨髓抑制、胃肠道反应的病例数分别有6、16和6例,不良事件发生率为60.87%;对照组患者不良事件发生率显著高于观察组,差异具有统计学意义(χ^(2)=7.095,P=0.036)。结论:老年MDS患者化疗耐受性低。减低剂量阿扎胞苷治疗老年MDS患者显示出良好的疗效和安全性。Objective:To analyze the efficacy and safety of low-dose azacitidine in the treatment of senile myelodysplastic syndromes(MDS).Methods:A total of 92 elderly MDS patients who were initially diagnosed in the Huaibei Miners General Hospital and the Affiliated Hospital of Xuzhou Medical University from January 2018 to June 2022 were randomly divided into the observation group and the control group with 46 patients in each group.The observation group received a low dose of azacitidine 100 mg/d,d1-7,28 days as a course of treatment,6 courses in total,and the control group received a standard dose of azacitidine 75 mg(m^(2)·d),d1-7,28 days as a course of treatment,a total of 6 courses of treatment.The clinical efficacy,overall survival(OS)and adverse reactions of the two groups of patients were observed.Results:There was no statistically significant difference in the clinical data between the two groups(P>0.05).After treatment,the hemoglobin and platelet levels of the two groups of patients were significantly higher than before treatment in each group(P<0.05).There was no statistically significant difference in leukocyte,hemoglobin and platelet levels between patients in the observation group and control group(P>0.05).The number of cases with complete remission,partial remission,hematological remission,disease stabilization and disease progression in the observation group were4,10,22,6and4,respectively,with a total effective rate of78.26%.The numbers of cases with complete remission,partial remission,hematological remission,disease stabilization and disease progression in control group were8,12,18,4and4,respectively,with a total effective rate of82.61%.The total effective rate of patients in the observation group was slightly lower than that of the control group(χ^(2)=0.457,P=0.254).There was no significant difference between the two treatment schemes in the treatment of patients with blood transfusion dependence and patients with low risk,medium risk and high risk(P>0.05).It takes4and6courses of treatment to achieve

关 键 词：骨髓增生异常综合征 老年患者 减低剂量 阿扎胞苷 

分 类 号：R551.3[医药卫生—血液循环系统疾病]