全反式维甲酸联合三氧化二砷双药诱导缓解治疗对初治急性早幼粒细胞白血病患者肝功能的影响

摘要

Objective To study the influence of the combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) on liver function in newly diagnosed patients with acute promeylocytic leukemia (APL).Methods Eighty newly diagnosed patients were involved in this retrospective study.Among them,thirty-eight patients were treated with ATRA and ATO,while forty-two were treated with ATRA or ATO alone.The efficiency and liver dysfunction rate in two groups were compared.Results There was no significantly statistical difference in CR rates between the combination group and one drug group [94.7 ％ (36/38) vs 90.5 ％ (38/42),P ＞ 0.05],while the difference was significant in time to remission [27 d (20-36 d) vs 35 d (25-49 d),P ＜ 0.05].Liver dysfunction rate,intermediate and severe liver dysfunction rate were higher in combination group than those in one drug group [68.4 ％ (18/42) vs 42.9 ％ (26/38),P ＜ 0.05; 39.5 ％ (15/38) vs 9.5 ％ (4/42),P ＜ 0.05].Alanine aminotransferase (ALT),aspartate aminotransferase (AST) abnormity rates and ALT,AST peak levels were significantly higher in combination group than in one drug group (all P ＜ 0.05).There were no significant differences in time to liver dysfunction,serum total bilirubin (STB), alkaline phosphatase (ALP),γ-glutamyl transferase (GGT) abnormity rates between the two groups (all P ＞ 0.05).Conclusion More serious hepatotoxicity is observed in patients treated with ATRA and ATO,indicating that monitoring of liver function and simultaneous liver protection therapy are necessary when treated with combination of ATRA and ATO.%目的 探讨全反式维甲酸(ATRA)联合三氧化二砷(ATO)诱导缓解治疗急性早幼粒细胞白血病(APL)期间患者肝功能的变化.方法 回顾性分析80例初治APL患者临床资料,其中38例经ATRA联合ATO双药诱导,42例经ATRA或ATO单药诱导,比较两组疗效及肝损害的差异.结果 双药诱导组和单药诱导组完全缓解(CR)率差异无统计学意义[94.7 ％(36/38)比90.5％(38/42),P＞0.05];双药诱导组CR时间短于单药诱导组[27d(20～36d)比35 d(25～49 d),P＜0.05].双药诱导组肝功能异常的发生率高于单药诱导组[68.4％(26/38)比42.9％(18/42),P＜0.05];中+重度肝功能异常的发生率高于单药诱导组[39.5 ％(15/38)比9.5％(4/42),P＜0.05].双药诱导组丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)异常率以及异常ALT和AST检测峰值均高于单药诱导组(P＜0.05);两组开始出现肝功能异常的时间以及血清总胆红素、碱性磷酸酶、γ-谷氨酰转肽酶异常率的差异无统计学意义(P＞0.05).结论 ATRA联合ATO双药诱导缓解治疗APL加重了肝脏毒性,治疗的同时需密切监测肝功能,及时行保肝治疗.