HAG联合地西他滨治疗骨髓异常增生综合征对患者血管内皮生长因子和生存质量的影响

摘要

目的 探讨HAG(高三尖杉酯碱+阿糖胞苷+粒细胞集落刺激因子)联合地西他滨治疗骨髓增生异常综合征临床效果并对安全性进行评价.方法 骨髓异常增生综合征患者86例随机分为HAG组和联合组,每组43例.HAG组采用高三尖杉酯碱静脉滴注,1 mg/d,1次/d;阿糖胞苷静脉滴注.,2 mg/kg,1次/d;粒细胞集落刺激因子300μg/d静脉滴注,1次/d;连续应用14 d.联合组在HAG组治疗基础上加用地西他滨,静脉滴注15 mg/m2,连续输注3h以上,每8小时1次,连用3d.观察2组患者治疗前后血管内皮生长因子、白细胞、血小板和血红蛋白水平;观察2组治疗前后血管内皮生长因子、骨髓中原始细胞水平、国际骨髓增生异常综合征预后积分系统(IPSS)评分、美国MD Anderson肿瘤中心预后(MDACC)评分、EORTC QLQ2C30生存质量量表评分(主要症状、伴随情况、情绪功能、认知程度、满意程度),采用抗癌药物常见不良反应分级标准观察患者不良反应发生情况.结果 2组治疗后第1、3、7、14天血管内皮生长因子水平均显著低于治疗前,且呈逐渐下降趋势,联合组低于HAG组,差异均有统计学意义(P＜0.05).2组治疗后骨髓中原始细胞所占比例显著低于治疗前,且HAG组高于联合组,差异有统计学意义(P＜0.05).2组治疗后IPSS评分中极低危+低危比例分高于治疗前,差异有统计学意义(P＜0.05),2组治疗后比较,差异有统计学意义(P＜0.05).HAG组0～6分所占比例治疗前后比较,差异无统计学意义(P＞0.05),联合组后0～6分所占比例高于治疗前,且高于HAG组,差异均有统计学意义(P＜0.05).2组治疗后主要症状、伴随情况、情绪功能、认知程度、满意程度评分均低于治疗前,差异有统计学意义(P＜0.05).联合组治疗后主要症状、伴随情况、情绪功能、认知程度均低于HAG组,差异有统计学意义(P＜0.05).联合组肺部感染、恶心呕吐发生率高于HAG组,差异有统计学意义(P＜0.05).2组血小板减少、肝功能受损和骨髓抑制发生率比较,差异无统计学意义(P＞0.05).结论 HAG联合地西他滨治疗骨髓增生异常综合征可以显著改善患者血管内皮生长因子水平降低骨髓中原始细胞所占比例,改善患者预后评分和生活质量,具有较好的临床应用价值.%Objective To investigate the therapeutic effects and safety of HAG (homoharringtonine and cytarabine and granulocyte colony-stimulating factor) combined with decitabine on myelodysplastic syndrome.Methods Eighty-six patients with myelodysplastic syndromes were randomly divided into HAG group and combination treatment group,with 43 patients in each group.The patients in HAG group were given homoharringtonine by intravenous injection,1 mg/d,once a day + cytarabine intravenous infusion,2mg/kg,once a day + granulocyte colony-stimulating factor 300g/d intravenous drip,1 times/d,for 14 days.However the patients in combination treatment group,on basis of HAG group,were given decitabine by intravenous infusion,15mg/m2,once every 8 hours,continuous infusion for more than 3 hours.Then the levels of vascular endothelial growth factor,interleukin-3,platelet and hemoglobin,bone marrow initial cells,the syndrome of abnormal bone marrow hyperplasia international prognostic scoring system (IPSS) score,MD Anderson Cancer Center (MDACC) score,prognosis of EORTC QLQ2C30 quality of life scale score (the main symptoms,emotional function,cognition function,satisfaction degree),adverse reactions according to anticancer drug common adverse reaction classification standard were observed and compared between two groups.Results The levels of vascular endothelial growth factor on 1d,3d,7d,14d after treatment were significantly decreased in both groups,as compared with those before treatment,with a gradual decrease trend,moreover,which in combination treatment group were significantly lower than those in HAG group (P ＜ 0.05).The proportion of bone marrow initial cells was significantly lower than that before treatment in both groups,however,which in HAG group was significantly higher than that in combination treatment group (P ＜ 0.05).The moderate risk + low risk proportion scores of IPSS score were significantly increased in both groups,as compared with those before treatment (P ＜ 0.05).However there was no significant difference in the proportion of 0 ～ 6 points in HAG group before and after treatment (P ＞ 0.05),moreover,which in combination treatment group was higher than that before treatment and significantly higher than that in HAG group (P ＜ 0.05).After treatment the main symptoms,emotional function,cognition degree,satisfaction degree scores in both groups were significantly lower than those before treatment (P ＜ 0.05),moreover,which in combination treatment group after treatment were significantly lower than those in HAG group (P ＜ 0.05).The incidence rates of pulmonary infection,nausea and vomiting in combination treatment group were significantly lower than those in HAG group (P ＜ 0.05),however,there were no significant differences in the incidence rates of thrombocytopenia,liver dysfunction and bone marrow suppression between two groups (P ＞ 0.05).Conclusion HAG combined with decitabine in treatment of myelodysplastic syndrome can significantly improve the levels of vascular endothelial growth factor,decrease bone marrow initial cells and improve prognosis and life quality of patients.