本文選題：慢性粒細(xì)胞白血病 + 伊馬替尼　； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:通過對(duì)遵醫(yī)附院58例伊馬替尼(imatinib)治療慢性粒細(xì)胞白血病慢性期(Chronic myelogenous leukemia in Chronic Phase,CML-CP)患者的療效及安全性的分析,探討影響分子反應(yīng)的相關(guān)因素。方法:對(duì)遵醫(yī)附院2010年1月至2016年1月血液內(nèi)科門診及病房收治的58例持續(xù)口服伊馬替尼200mg/d或400mg/d的初診CML-CP患者,通過觀察治療時(shí)間≥1年的血象、臨床表現(xiàn)、BCR/ABL轉(zhuǎn)錄本的改變情況、治療期間藥物毒副作用,分析分子療效的相關(guān)因素。結(jié)果:統(tǒng)計(jì)顯示58例初診CML-CP患者使用伊馬替尼治療12個(gè)月的臨床療效,其中有19例(32.76%)患者BCR/ABL IS≤0.1%(最佳反應(yīng)),16例(27.59%)患者BCR/ABL IS0.1%且≤1%(警告),23例(39.65%)患者BCR/ABL IS1%(治療失敗)。觀察期內(nèi)(12個(gè)月)血液學(xué)不良反應(yīng)有23例(39.65(4))患者發(fā)生III級(jí)和IV級(jí)粒細(xì)胞減少,其中12例患者粒細(xì)胞IV級(jí)減少。14例(24.14%)患者發(fā)生III級(jí)和IV級(jí)血小板減少,其中7例患者血小板IV級(jí)減少。有7例患者粒細(xì)胞及血小板均發(fā)生III級(jí)和IV級(jí)減少。非血液學(xué)不良反應(yīng)中顏面部及雙下肢水腫16例(27.59%),胃腸道反應(yīng)14例(24.14%),皮疹11例(18.97%),關(guān)節(jié)痛及肌肉痙攣8例(13.17%),予間斷停藥或減量后均能耐受。單因素分析顯示:治療過程中是否規(guī)則用藥(停藥≥1月與停藥1月,P=0.005)、治療過程中是否發(fā)生III級(jí)和IV級(jí)血小板減少(發(fā)生與未發(fā)生,P=0.014)是影響分子反應(yīng)的相關(guān)因素。治療過程中是否發(fā)生III級(jí)和IV級(jí)血小板減少(發(fā)生與未發(fā)生,P=0.025)是影響無疾病進(jìn)展生存期(Progression-free survival,PFS)相關(guān)因素。結(jié)論:(1)本組58例初診CML-CP患者使用伊馬替尼治療12個(gè)月僅有32.76%達(dá)最佳反應(yīng),未達(dá)到預(yù)期治療效果,可能與患者不良依從性、經(jīng)濟(jì)原因及醫(yī)務(wù)人員宣傳教育不夠有關(guān)。(2)是否規(guī)則用藥、是否發(fā)生III級(jí)和IV級(jí)血小板減少是影響分子反應(yīng)的相關(guān)因素,其中是否發(fā)生III級(jí)和IV級(jí)血小板減少是影響PFS相關(guān)因素。
[Abstract]:Objective: to evaluate the efficacy and safety of imatinib in the treatment of chronic myeloid leukemia (CML) in 58 patients with chronic myeloid leukemia (CML). Methods: from January 2010 to January 2016, 58 newly diagnosed CML-CP patients who had been treated with 200mg/d or 400mg/d for continuous oral administration of imatinib or 400mg/d were studied by observing the blood picture of the patients who had been treated for more than one year from January 2010 to January 2016. Clinical manifestations of BCR / ABL transcripts, drug side effects during treatment, and factors related to molecular efficacy were analyzed. Results: statistics showed that there were 58 newly diagnosed CML-CP patients treated with imatinib for 12 months, including 19 patients with BCR / ABL IS 鈮，

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