培门冬酶与左旋门冬酰胺酶治疗Ph阴性急性淋巴细胞白血病的对比研究

贾韬　王莹　朱原辛　毛建平　薛连国　魏计锋　陈泽　赵利东

[摘要] 目的 比较培门冬酶与左旋门冬酰胺酶治疗Ph阴性急性淋巴细胞白血病的效果及安全性。 方法 回顾性分析连云港市第一人民医院2007年1月～2018年3月收治的52例Ph阴性急性淋巴白血病患者的临床资料，患者均接受VDCLP方案化疗，按照用药分为培门冬酶组（25例）与左旋门冬酰胺酶组（27例），比较两组的疗效、不良反应及生存情况。 结果 培门冬酶组及左旋门冬酰胺酶组患者的一般資料比较，差异无统计学意义（P > 0.05）。两组总有效率比较，差异无统计学意义（P > 0.05）。左旋门冬酰胺酶组的过敏发生率及高血糖发生率高于培门冬酶组（P < 0.05），培门冬酶组的纤维蛋白原（FIB）最低值较左旋门冬酰胺酶组高，活化部分凝血活酶时间（APTT）持续增高时间较左旋门冬酶胺组短（P < 0.05）。 结论 培门冬酶治疗Ph阴性急性淋巴细胞白血病效果好、安全，值得临床推广。

[关键词] Ph阴性；急性淋巴细胞白血病；培门冬酶；左旋门冬酰胺酶

[中图分类号] R733 [文献标识码] A [文章编号] 1673-7210（2018）09（b）-0117-04

[Abstract] Objective To compare the efficacy and security between pegaspargase and L-asparaginase in the treatment of Ph-negative acute lymphoblastic leukemia. Methods Clinical data of 52 Ph-negative acute lymphoblastic leukemia cases admitted to the First People′s Hospital of Lianyungang from January 2007 to March 2018 were retrospectively analyzed. All the cases received VDCLP chemotherapy and were divided into the pegaspargase group （25 cases） and the L-asparaginase group （27 cases）. The efficacy， adverse reactions and survival status between the two groups were compared. Results The general information between the two groups were homogeneous， there was no statistically significant difference （P > 0.05）. There was no statistically significant difference in the total effective rate between the two groups （P > 0.05）. The incidence of allergic reactions and hyperglycemia in the L-asparaginase group was higher than that in the pegaspargase group （P < 0.05）. The minimum value of fibrinogen （FIB） in the pegaspargase group was bigger than the L-asparaginase group， and the duration rise time of activated partial thromboplastin time in the pegaspargase group was shorter than the L-asparaginase group （P < 0.05）. Conclusion Pegaspargase is effective and safe in the treatment of Ph-negative acute lymphoblastic leukemia and it is worth of clinical promotion.

[Key words] Ph-negative； Acute Lymphoblastic Leukemia； Pegaspargase； L-asparaginase

急性淋巴细胞白血病（acute lymphoblastic leukemia，ALL）是一种异质性较大的血液科恶性疾病，发病率呈现青少年和老年两个高峰[1-3]。费城染色体（Ph）阳性的ALL由于络氨酸激酶抑制剂的应用，疗效已明显提高[4-6]。而Ph阴性ALL的治疗仍以联合化疗为主[7]，目前广泛使用经典的VDCLP方案对Ph阴性ALL进行诱导化疗[8]。既往左旋门冬酰胺酶（L-asparaginase，L-Asp）是VDCLP方案的主要组成药物，其通过阻断白血病细胞蛋白质合成达到抗肿瘤作用[9-10]。由于L-Asp的外源性蛋白质的特点，常出现严重过敏、凝血功能异常等不良反应，影响了该药物的临床应用[11-13]。国产的聚乙二醇化门冬酰胺酶即培门冬酶（Pegaspargase，PEG-Asp），降低外源性蛋白质免疫原性的同时还延长了药物半衰期，已应用于国内儿童ALL的治疗中[14]。但目……