本文關(guān)鍵詞： 急性髓細(xì)胞白血病 完全緩解率 去甲氧柔紅霉素 國產(chǎn) 進(jìn)口 柔紅霉素 不良反應(yīng)　出處：《河北醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:急性髓系白血病(acute myeloid leukemia,AML)是骨髓造血干/祖細(xì)胞起源的惡性疾病,是一個具有高度異質(zhì)性的疾病群,多數(shù)病例發(fā)病急,病情重,預(yù)后差,如不及時(shí)治療中位生存期僅3個月。目前,經(jīng)典的AML誘導(dǎo)緩解方案是以蒽環(huán)類藥物聯(lián)合阿糖胞苷的“3+7”方案,同時(shí)包括成份輸血、及時(shí)有效的抗生素使用等強(qiáng)有力支持治療使AML預(yù)后得到較大改善。國內(nèi)外研究顯示,AML患者治療完全緩解率可達(dá)65%-85%。作為新型蒽環(huán)類藥物,去甲氧柔紅霉素與柔紅霉素一樣,成為急性髓系白血病的常用誘導(dǎo)藥物,但目前國內(nèi)外對兩種藥物的療效差異尚無明確定論。另一方面,因國人經(jīng)濟(jì)耐受力不同,近年來,國產(chǎn)去甲氧柔紅霉素(艾諾寧)在臨床上已被廣泛使用,其治療效果、毒副作用與進(jìn)口去甲氧柔紅霉素(善唯達(dá))的療效差異尚無明確定論。目的:觀察并分析去甲氧柔紅霉素(IDA)(國產(chǎn)、進(jìn)口)與柔紅霉素(DNR)分R%聯(lián)合阿糖胞苷化療治療成人初治非M3型急性髓系白血病的療效及毒副作用。方法:回顧性分析河北醫(yī)科大學(xué)第二醫(yī)院血液科就診的282例初治AML患者的臨床資料,初診時(shí)間2012年7月1日~2015年11月30日。其中應(yīng)用IA方案(去甲氧柔紅霉素(8-10)mg/m2/d,d1-3;阿糖胞苷(100-200)mg/m2/d,d1-7)221例,善唯達(dá)123例,艾諾寧98例;應(yīng)用DA方案(柔紅霉素(45-60)mg/m2/d,d1-3;阿糖胞苷劑量同IA方案)61例。分析并比較三組病例治療后的臨床療效及不良反應(yīng)的發(fā)生情況。結(jié)果:1三種方案治療成人初治非M3型AML的CR率由高到低分別為:善唯達(dá)組85.4%、艾諾寧組75.5%、柔紅霉素組57.4%,三組比較有統(tǒng)計(jì)學(xué)差異(P0.001),三組不良反應(yīng)無明顯差異;2與柔紅霉素相比,去甲氧柔紅霉素療效較好,且療效與用藥劑量成正比。與善唯達(dá)相比,艾諾寧治療緩解率略低;3三種藥物療效顯著,三組主要的化療相關(guān)不良反應(yīng)均為骨髓抑制、感染、惡心嘔吐等。不良反應(yīng)在可控范圍,均可作為一線應(yīng)用的抗白血病藥物。結(jié)論:三種藥物聯(lián)合阿糖胞苷誘導(dǎo)治療成人初治急性髓系白血病,均可起到顯著療效。去甲氧柔紅霉素CR率高于柔紅霉素,在用藥劑量區(qū)間中,療效與用藥劑量成正比,毒副反應(yīng)可控。國產(chǎn)去甲氧柔紅霉素可達(dá)到與進(jìn)口藥物相近的治療效果,可作為臨床一線應(yīng)用的抗白血病藥物。
[Abstract]:Background: acute myeloid leukemia (myeloid) is a malignant disease of bone marrow hematopoietic stem / progenitor cells. Is a highly heterogeneous disease group, most of the cases are acute, severe, poor prognosis, such as failure to treat the median survival period of only 3 months. At present. The classic AML induced remission regimen is the "37" regimen with anthracyclines combined with cytarabine, which also includes component blood transfusions. Prompt and effective use of antibiotics and other powerful support therapy can improve the prognosis of AML. Domestic and foreign studies show that. As a new anthracycline, daunorubicin, like daunorubicin, has become a common inducer of acute myeloid leukemia. On the other hand, because of the different economic tolerance of Chinese people, in recent years, domestic noroxonorubicin (Einonine) has been widely used in clinic. There is no clear conclusion on the therapeutic effect, side effects and the difference between imported normoxydaunorubicin and imported daunorubicin. Objective: to observe and analyze the effect of normoxydaunorubicin (IDA). Import) and daunorubicin (DNR). The efficacy and side effects of R% combined with cytarabine chemotherapy in the treatment of non-M3 type acute myeloid leukemia in adults were studied. The clinical data of 282 newly diagnosed AML patients in hematology department of the second Hospital of Hebei Medical University were analyzed retrospectively. The first visit was from July 1st 2012 to November 30th 2015. IA regimen was used. Cytosine arabinoside 100 ~ 200 mg / m ~ (2) / d ~ (-1) D _ (1-7) in 221 cases, Shanwei in 123 cases, Einonine in 98 cases; DA regimen (daunorubicin 45-60 mg / m2 / dnd1-3; Cytarabine dose is the same as IA regimen). 61 cases were analyzed and compared the clinical efficacy and adverse reactions after treatment in three groups. Results the CR rate of non-M3 type AML in adults treated with three different regimens of 1: 1 was from high to low, respectively. Group 85.4%. Einonine group 75.5 and daunorubicin group 57.4, there was significant difference among the three groups (P 0.001), there was no significant difference in adverse reactions among the three groups. 2Compared with daunorubicin, normoxydaunorubicin had a better curative effect, and the curative effect was proportional to the dosage. 3 the three drugs had significant curative effect. The main adverse reactions were bone marrow suppression, infection, nausea and vomiting in the three groups. The adverse reactions were in the controllable range. Conclusion: three drugs combined with cytosine arabinoside in the treatment of adult primary acute myeloid leukemia. The CR rate of normoxydaunorubicin was higher than that of daunorubicin. Domestic normoxydaunorubicin can achieve the same therapeutic effect as imported drugs and can be used as a clinical first-line antileukemia drug.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R733.71

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