本文關(guān)鍵詞： 三氧化二砷 砷劑 急性早幼粒細(xì)胞白血病 長期生存　出處：《中國中醫(yī)科學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:進(jìn)一步了解APL的發(fā)病特點(diǎn),分析含砷中藥對APL完全緩解率及長期生存的影響,觀察砷劑不同治療階段應(yīng)用的療效,分析以中藥砷劑為主方案治療APL的療程與時間,為進(jìn)一步優(yōu)化APL治療方案提供依據(jù)。方法:以我院1991年2月-2017年2月26年間收治的APL患者110例為研究對象。初治就診患者誘導(dǎo)及鞏固階段以砷劑為主治療;在外院經(jīng)維甲酸或者聯(lián)合化療誘導(dǎo)緩解后就診我院的患者以砷劑為主鞏固治療;復(fù)發(fā)/難治就診的患者使用砷劑再誘導(dǎo)。分析和比較所有APL患者的臨床特點(diǎn)和長期生存情況。應(yīng)用SPSS22.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,采用KapLan-Meier曲線分析比較不同治療方案對無復(fù)發(fā)生存率(RFS)、無事件生存率(EFS)和總生存率(OS)的影響。結(jié)果:110例APL患者,原發(fā)者占92.7%,腫瘤并發(fā)者占1.8%,銀屑病并發(fā)者占5.5%。初治APL患者誘導(dǎo)CR率100%。誘導(dǎo)階段即使用砷劑(初治就診APL患者)組10年RFS率為97.5%,明顯高于鞏固階段開始使用砷劑(鞏固就診APL 患者)組 80.6%(P0.05)。兩組 5 年和 10 年 EFS 率分別為(94.8%VS78.6%)、(91.5%VS78.6%)(P0.05);OS 率分別為(94.8%VS86.4%)、(91.5%VS83.6%)(P0.05);復(fù)發(fā)就診APL患者誘導(dǎo)CR率87.5%,10年OS率34.1%。生存5年且持續(xù)在我院治療的29例初治APL患者,鞏固維持治療2.5個月～103個月,12～24個月者6例,平均AS_2O_3用量5.7±1.84個療程,化療2.75±0.75個療程;25～36個月者7例,平均AS_2O_3用量7.44±1.02個療程,化療3±0.55個療程;37～48個月者8例,平均AS_2O_3用量12.04±2.17個療程,化療3±0.58個療程;49～60個月者1例,使用AS_2O_310個療程,化療5個療程;60個月者3例,平均AS_2O_3用量15.32±6.61個療程,化療4.5±3.5個療程;4例治療12個月。13.3%初治APL患者在誘導(dǎo)過程中出現(xiàn)明顯肝損害(ALT或AST300u/L),嚴(yán)重神經(jīng)毒性反應(yīng)者1例;共發(fā)現(xiàn)2例APL患者治療后并發(fā)第2腫瘤。結(jié)論:(1)在APL治療中,早期使用中藥砷劑能明顯提高緩解率,降低復(fù)發(fā)率。(2)鞏固期開始使用中藥砷劑比誘導(dǎo)期即使用復(fù)發(fā)患者增加,提倡在誘導(dǎo)期即采取以砷劑為主的誘導(dǎo)方案。(3)復(fù)發(fā)患者雖然多數(shù)可取得再次緩解,但緩解期短,長期無病生存率約占1/3。(4)以砷劑為主治療方案仍具有優(yōu)化的空間,砷劑的近遠(yuǎn)期毒性仍需關(guān)注。
[Abstract]:Objective: to investigate the characteristics of APL, to analyze the effect of arsenic containing Chinese medicine on the complete remission rate and long-term survival of APL, and to observe the curative effect of arsenic in different stages of treatment. To analyze the course and time of treating APL with traditional Chinese medicine arsenic as the main regimen. To provide the basis for further optimization of APL treatment. Methods:. 110 cases of APL patients admitted from February 1991 to February 26th 2017 in our hospital were studied. The patients in our hospital treated by retinoic acid or chemotherapy-induced remission were mainly treated with arsenic. The recurrent / refractory patients were reinduced by arsenic. The clinical characteristics and long-term survival of all patients with APL were analyzed and compared. SPSS22.0 software was used for statistical analysis. The recurrence free survival rate (RFSs) of different treatment regimens was compared by KapLan-Meier curve analysis. Results among the 110 patients with APL, 92. 7% were primary and 1.8% were complicated with tumor. The CR rate of the patients with primary APL was 100. In the induction stage, the RFS rate of 10 years was 97.5% in the arsenic group (initial treatment for APL patients). The EFS rates of the two groups were significantly higher than that of the group starting to use arsenic (consolidation of APL patients) in the period of consolidation (P 0.05). The EFS rates of the two groups were 5 and 10 years (P < 0.05). 94.8 VS78.6). VS78.6 and P0.05; The OS rates were 91.5 VS83.6 and 91.5 VS86.4, respectively. The induction CR rate was 87.5% in recurrent APL patients, and the OS rate was 34.1% in 10 years. 29 newly treated APL patients survived 5 years and continued to be treated in our hospital. The average dosage of AS_2O_3 was 5.7 鹵1.84 courses and 2.75 鹵0.75 courses of chemotherapy. The average dosage of AS_2O_3 was 7.44 鹵1.02 courses and 3 鹵0.55 courses of chemotherapy. The average dosage of AS_2O_3 was 12.04 鹵2.17 courses of treatment and 3 鹵0.58 courses of chemotherapy. One case of 49 ~ 60 months was treated with AS_2O_310 for five courses of chemotherapy. The average dosage of AS_2O_3 was 15.32 鹵6.61 course of treatment and 4.5 鹵3.5 course of chemotherapy. After 12 months of treatment, 4 patients with newly treated APL had significant liver damage, alt or AST 300u / L, and 1 patient had severe neurotoxic reaction. A total of 2 patients with APL were found to be complicated with the second tumor after treatment. Conclusion the early use of arsenic in the treatment of APL can significantly improve the remission rate. Reduce the recurrence rate. 2) beginning to use as in the consolidation period is higher than that in the induction stage, even in the patients with recurrence. It is recommended that the induction regimen with arsenic as the main inducer should be adopted in the induction period. Although most of the relapse patients can obtain the second remission, the remission period is short. Long-term disease-free survival rate accounts for about 1 / 3. 4) arsenic as the main therapeutic regimen still has room for optimization, and the short-term and long-term toxicity of arsenic still needs to be paid attention to.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R733.71

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