本文選題：培門冬酶　切入點：兒童　出處：《蘇州大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的:探究培門冬酶(PEG-Asp)與左旋門冬酰胺酶(L-Asp)比較,在兒童急性淋巴細胞白血病(ALL)誘導化療中的應用,以及PEG-Asp體外活性變化的意義。方法:回顧性分析本院2014年1月至2014年12月124例初診ALL患兒,PEG-Asp組51例,L-Asp組73例,評價兩組在誘導化療中的不良反應及療效。選取本院2015年6月至2015年12月間15例初診ALL患兒,均在使用國產培門冬酶后D1、D15天監(jiān)測PEG-Asp活性及底物濃度。結果:(1)入組患兒共124例,兩組初診患兒在過敏反應、肝功能異常、急性胰腺炎、血栓形成、關節(jié)疼痛、胃腸道反應等不良反應方面發(fā)生率相似,差異無統(tǒng)計學意義(P0.05)。(2)PEG-Asp組具有較高的凝血功能異常發(fā)生率和低蛋白血癥發(fā)生率,與L-Asp組比,APTT、PT延長及FIB、AT-III降低發(fā)生率明顯增高,差異有統(tǒng)計學意義(P0.05),兩組APTT、PT均以1級障礙為主,FIB均以2、3級障礙為主。(3)PEG-Asp組51例,CR率90.2%,總有效率94.1%;L-Asp組73例,CR率91.8%,總有效率94.5%,兩組差異無統(tǒng)計學意義(P0.929)。(4)誘導治療中,D1天血清PEG-Asp活性均值為289.27±260.193IU/L,D15血清PEG-Asp活性均值為466.20±273.978IU/L(最低下限值為75 IU/L);D1、D15血清門冬酰胺(ASN)底物濃度低于最低下限值(150ng/ml)。結論:(1)PEG-Asp與L-Asp在兒童ALL誘導化療中療效無差異;(2)與L-Asp組相比,PEG-Asp組在凝血功能異常和低蛋白血癥發(fā)生率較高;(3)監(jiān)測PEG-Asp活性和底物濃度變化可作為評價其是否有治療效價的依據(jù)。
[Abstract]:Objective: to explore the application of peg Aspp and L-Aspp in inducing chemotherapy in children with acute lymphoblastic leukemia (ALL). Methods: from January 2014 to December 2014, the changes of activity of PEG-Asp in vitro were analyzed retrospectively in 51 cases of PEG-Asp group and 73 cases of L-Asp group from January 2014 to December 2014. To evaluate the adverse reactions and efficacy of the two groups in induced chemotherapy, 15 patients with ALL were selected from June 2015 to December 2015. The activity of PEG-Asp and the concentration of substrate were monitored by D1C D15 days after the use of domestic aspartic enzyme. The incidence of allergic reaction, abnormal liver function, acute pancreatitis, thrombosis, joint pain and gastrointestinal reaction were similar between the two groups. There was no significant difference in the incidence of coagulation dysfunction and hypoproteinemia in the PEG-Asp group. Compared with the L-Asp group, the APTTT-PT prolonged and the FIBAT-III decreased significantly higher than that in the L-Asp group. The difference was statistically significant (P 0.05). The two groups of APTTT PT were mainly grade 1 disorder and FIB were mainly 2 or 3 grade disorder. The CR rate was 90.2 in 51 cases in PEG-Asp group, and the total effective rate was 91.8% in L-Asp group, and the total effective rate was 94.55.There was no significant difference between the two groups (P > 0.05). There was no significant difference between the two groups in the CR rate of 73 cases and the total effective rate of 91.8% in the L-Asp group. There was no significant difference between the two groups (P > 0.05). The mean value of serum PEG-Asp activity was 289.27 鹵260.193 IUP / L on day 1 after induction therapy, and the mean value of serum PEG-Asp activity was 466.20 鹵273.978 IUU / L (the lowest limit was 75 IUL / L ~ (1) D _ (1) D _ (15) serum asparagine) substrate concentration below the minimum limit of 150 ng / ml 路ml ~ (-1). Conclusion there is no effect of PEG-Asp and L-Asp in children with ALL induced chemotherapy. Compared with L-Asp group, PEG-Asp group had a higher incidence of coagulation dysfunction and hypoproteinemia. Monitoring the activity of PEG-Asp and the change of substrate concentration could be used as a basis for evaluating the therapeutic titer of PEG-Asp group.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R733.71

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