不同剂量阿糖胞苷治疗中高危骨髓增生异常综合征临床效果研究  

Application study of different doses of cytarabine in the treatment of high-risk MDS

作　　者：周勤晓 安艳萍 张楠[1] Zhou Qinxiao;An Yanping;Zhang Nan(Department of Hematology,Third Ward,First Affiliated Hospital of Zhengzhou University,Henan 450000,China)

机构地区：[1]郑州大学第一附属医院血液内科三病区,450000

出　　处：《山西医药杂志》2024年第19期1443-1447,共5页Shanxi Medical Journal

基　　金：河南省医学科技攻关项目(SBGJ202101025)。

摘　　要：目的观察不同剂量阿糖胞苷治疗中高危骨髓增生异常综合征(MDS)的临床效果。方法本次研究将选取郑州大学第一附属医院2021年1月至2022年12月收治的119例中高危MDS患者为研究对象,开展前瞻性、随机对照试验。应用计算机随机分组法将入组患者分别列为常规组(59例)、小剂量组(60例),2组均采用阿糖胞苷联合阿扎胞苷治疗,常规组予以常规剂量阿糖胞苷,小剂量组予以小剂量阿糖胞苷,所有患者治疗后随访1年,比较2组患者的外周血象指标、近期疗效、代谢指标、肿瘤相关基因甲基化率及治疗安全性。结果在不同治疗方案下,小剂量组的白细胞计数(WBC)、血小板计数(PLT)分别为(4.3±1.2)×10^(9)/L、(82.4±10.4)×10^(9)/L,略低于常规组[(4.8±1.4)×10^(9)/L、(85.4±10.3)×10^(9)/L];小剂量组的总缓解率86.7%(52/60)略低于常规组89.8%(53/59);小剂量组的铁蛋白、维生素B12、维生素b9分别为(195.4±20.4)μg/L、(475.4±20.3)pg/L、(5.7±1.4)mg/L,略高于常规组[(192.3±20.4)μg/L、(471.3±20.5)pg/L、(5.4±1.4)mg/L];小剂量组的肿瘤抑制因子p15、细胞因子信号传导抑制因子1(SOCS1)甲基化率分别为6.7%(4/60)、5.0%(3/60),略高于常规组[3.4%(2/59)、1.7%(1/59)],差异无统计学意义(P>0.05)。小剂量的药物相关不良反应发生率3.3%(2/60)低于常规组17.0%(10/59),差异具有统计学意义(P<0.05)。结论小剂量阿糖胞苷辅助治疗中高危MDS可在不影响患者外周血象、近期疗效、代谢指标或增加肿瘤相关基因甲基化率同时,降低药物相关不良反应发生风险。Objective To observe the clinical efficacy of different doses of cytarabine in the treatment of high-risk myelodysplastic syndrome(MDS).Methods This study will focus on 119 patients with medium to high-risk MDS admitted to our hospital from January 2021 to December 2022,and conduct a prospective,randomized controlled trial.Using the computer random grouping method,the enrolled patients were divided into a conventional group(59 cases)and a low-dose group(60 cases).Both groups were treated with a combination of cytarabine and azacitidine.The conventional group received a conventional dose of cytarabine,while the low-dose group received a low dose of cytarabine.All patients were followed up for one year after treatment,and the peripheral blood indicators,recent efficacy,metabolic indicators,tumor-related gene methylation rate,and treatment safety of the two groups were compared.Results Under different treatment regimens,the white blood cell(WBC)and platelets(PLT)of the low-dose group were(4.3±1.2)×10^(9)/L and(82.4±10.4)×10^(9)/L,slightly lower than the conventional group[(4.8±1.4)×10^(9)/L and(85.4±10.3)×10^(9)/L].The overall response rate of the low-dose group was 86.7%(52/60),slightly lower than the conventional group at 89.8%(53/59).The levels of ferritin,vitamin 12,and vitamin b9 in the low-dose group were(195.4±20.4)μg/L,(475.4±20.3)pg/L,(5.72±1.4)mg/L,slightly higher than the conventional group[(192.3±20.4)μg/L,(471.3±20.5)pg/L,(5.4±1.4)mg/L].The methy-lation rates of p15 and SOCS1 in the low-dose group were 6.7%(4/60)and 5.0%(3/60),slightly higher than the conventional group[3.4%(2/59)and 1.7%(1/59)](P>0.05).The incidence of side effects related to low-dose drugs was 3.3%(2/60)lower than the conventional group 16.95%(10/59)(P<0.05).Conclusion Lowdose cytarabine as an adjuvant therapy for high-risk MDS can reduce the risk of drug-related side effects without affecting the patient′s peripheral blood count,recent efficacy,metabolic indicators,or increasing the methylation rate of tumor related

关 键 词：骨髓增生异常综合征 阿糖胞苷 外周血象 近期疗效 治疗安全性 

分 类 号：R551.3[医药卫生—血液循环系统疾病]