中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
2期
214-217
,共4页
王弘%王晔%李爽%迟昨非%郝良纯
王弘%王曄%李爽%遲昨非%郝良純
왕홍%왕엽%리상%지작비%학량순
急性早幼粒细胞白血病%儿童%三氧化二砷%器官功能损害
急性早幼粒細胞白血病%兒童%三氧化二砷%器官功能損害
급성조유립세포백혈병%인동%삼양화이신%기관공능손해
Acute promyelocytic leukemia%Childhood%Arsenic trioxide%Organ damage
目的 探讨治疗剂量三氧化二砷(As2O3)对急性早幼粒细胞白血病(APL)患儿肝脏、肾脏、心脏的毒副作用.方法 对65例初诊初治APL患儿应用As2O3静脉滴注诱导缓解治疗同时动态监测患儿肝脏、肾脏及心脏功能的毒性反应.结果 (1)65例患儿应用As2O3治疗后发生肝脏损害19例(29.2％),轻度15例(23.1％),中度4例(6.2％),治疗前丙氨酸氨基转移酶为(19.9±9.5) U/L,治疗第1、2周分别为(24.3±11.8)、(25.0±14.4) U/L,显著高于治疗前(P均＜0.05),治疗第3周基本恢复正常;治疗前天冬氨酸氨基转移酶为(28.5±8.8) U/L,治疗第1、2、3周分别为(38.3±16.5)、(39.1±15.5)、(35.3±20.6) U/L,显著高于治疗前(P＜0.05或0.01),第4周后基本恢复正常.(2)治疗前尿胱氨酸蛋白酶抑制剂C为(1.98±0.68) mg/L,治疗第2、3、4周分别为(2.51±1.45)、(3.05±1.13)、(2.46±1.21) mg/L,显著高于治疗前(P＜0.05或0.01);治疗前尿β2微球蛋白为(0.51±0.23) mg/L,治疗第2、3、4周分别为(1.08±0.45)、(0.69±0.55)、(0.71±0.48) mg/L,显著高于治疗前(P＜0.05或0.01);于治疗第5周降至正常.(3)9例患儿在诱导缓解期出现心悸、心前区不适及心率增快表现,均为轻度,在治疗3周后症状消失;肌酸激酶在治疗后第2周[(90.2 ±32.5) U/L]高于治疗前[(78.5±22.3)U/L],肌酸激酶同工酶在治疗第2、3周[(8.3±4.8)、(8.5±5.6) U/L]显著高于治疗前[(6.3±3.5) U/L],血清肌酸激酶同工酶质量在第4周时[(3.9±2.0)g/L]仍明显高于治疗前[(2.8±1.9)g/L],其后逐渐恢复正常.结论 常规剂量As2O3治疗小儿APL的肝脏、肾脏、心脏毒性较小,且为一过性、可逆性,多发生于As2O3治疗的第1～～3周.血丙氨酸氨基转移酶、天冬氨酸氨基转移酶和尿胱氨酸蛋白酶抑制剂、β2微球蛋白及血肌酸激酶同工酶质量为指示器官功能损害的敏感指标.
目的 探討治療劑量三氧化二砷(As2O3)對急性早幼粒細胞白血病(APL)患兒肝髒、腎髒、心髒的毒副作用.方法 對65例初診初治APL患兒應用As2O3靜脈滴註誘導緩解治療同時動態鑑測患兒肝髒、腎髒及心髒功能的毒性反應.結果 (1)65例患兒應用As2O3治療後髮生肝髒損害19例(29.2％),輕度15例(23.1％),中度4例(6.2％),治療前丙氨痠氨基轉移酶為(19.9±9.5) U/L,治療第1、2週分彆為(24.3±11.8)、(25.0±14.4) U/L,顯著高于治療前(P均＜0.05),治療第3週基本恢複正常;治療前天鼕氨痠氨基轉移酶為(28.5±8.8) U/L,治療第1、2、3週分彆為(38.3±16.5)、(39.1±15.5)、(35.3±20.6) U/L,顯著高于治療前(P＜0.05或0.01),第4週後基本恢複正常.(2)治療前尿胱氨痠蛋白酶抑製劑C為(1.98±0.68) mg/L,治療第2、3、4週分彆為(2.51±1.45)、(3.05±1.13)、(2.46±1.21) mg/L,顯著高于治療前(P＜0.05或0.01);治療前尿β2微毬蛋白為(0.51±0.23) mg/L,治療第2、3、4週分彆為(1.08±0.45)、(0.69±0.55)、(0.71±0.48) mg/L,顯著高于治療前(P＜0.05或0.01);于治療第5週降至正常.(3)9例患兒在誘導緩解期齣現心悸、心前區不適及心率增快錶現,均為輕度,在治療3週後癥狀消失;肌痠激酶在治療後第2週[(90.2 ±32.5) U/L]高于治療前[(78.5±22.3)U/L],肌痠激酶同工酶在治療第2、3週[(8.3±4.8)、(8.5±5.6) U/L]顯著高于治療前[(6.3±3.5) U/L],血清肌痠激酶同工酶質量在第4週時[(3.9±2.0)g/L]仍明顯高于治療前[(2.8±1.9)g/L],其後逐漸恢複正常.結論 常規劑量As2O3治療小兒APL的肝髒、腎髒、心髒毒性較小,且為一過性、可逆性,多髮生于As2O3治療的第1～～3週.血丙氨痠氨基轉移酶、天鼕氨痠氨基轉移酶和尿胱氨痠蛋白酶抑製劑、β2微毬蛋白及血肌痠激酶同工酶質量為指示器官功能損害的敏感指標.
목적 탐토치료제량삼양화이신(As2O3)대급성조유립세포백혈병(APL)환인간장、신장、심장적독부작용.방법 대65례초진초치APL환인응용As2O3정맥적주유도완해치료동시동태감측환인간장、신장급심장공능적독성반응.결과 (1)65례환인응용As2O3치료후발생간장손해19례(29.2％),경도15례(23.1％),중도4례(6.2％),치료전병안산안기전이매위(19.9±9.5) U/L,치료제1、2주분별위(24.3±11.8)、(25.0±14.4) U/L,현저고우치료전(P균＜0.05),치료제3주기본회복정상;치료전천동안산안기전이매위(28.5±8.8) U/L,치료제1、2、3주분별위(38.3±16.5)、(39.1±15.5)、(35.3±20.6) U/L,현저고우치료전(P＜0.05혹0.01),제4주후기본회복정상.(2)치료전뇨광안산단백매억제제C위(1.98±0.68) mg/L,치료제2、3、4주분별위(2.51±1.45)、(3.05±1.13)、(2.46±1.21) mg/L,현저고우치료전(P＜0.05혹0.01);치료전뇨β2미구단백위(0.51±0.23) mg/L,치료제2、3、4주분별위(1.08±0.45)、(0.69±0.55)、(0.71±0.48) mg/L,현저고우치료전(P＜0.05혹0.01);우치료제5주강지정상.(3)9례환인재유도완해기출현심계、심전구불괄급심솔증쾌표현,균위경도,재치료3주후증상소실;기산격매재치료후제2주[(90.2 ±32.5) U/L]고우치료전[(78.5±22.3)U/L],기산격매동공매재치료제2、3주[(8.3±4.8)、(8.5±5.6) U/L]현저고우치료전[(6.3±3.5) U/L],혈청기산격매동공매질량재제4주시[(3.9±2.0)g/L]잉명현고우치료전[(2.8±1.9)g/L],기후축점회복정상.결론 상규제량As2O3치료소인APL적간장、신장、심장독성교소,차위일과성、가역성,다발생우As2O3치료적제1～～3주.혈병안산안기전이매、천동안산안기전이매화뇨광안산단백매억제제、β2미구단백급혈기산격매동공매질량위지시기관공능손해적민감지표.
Objective To explore the adverse effect of arsenic trioxide (As2O3) on liver,kidney and heart function during treating children patients with acute promyelocytic leukemia (APL) at therapeutic dose.Methods Sixty-five APL cases received As2O3 by intravenous drip and organic toxicity were selected as our subjects.The indices of liver,heart and kidney were measured.Results Of all subjects,19 cases(29.2％) occurred liver damage,including 15 cases(23.1％) mild and 4 cases(6.2％) moderate toxicity.The levels of alanine aminotransferase of patients before treatment was (19.9 ±9.5) U/L,and (24.3 ± 11.8) U/L,(25.0 ± 14.4) U/L at 1 st and 2nd weeks after treatment,higher than those before the treatment (P ＜ 0.05).However,level of alanine aminotransferase was back to normal at 3th weeks after treatment.Meanwhile the levels of aspartate aminotransferase at 1st,2nd and 3th weeks after treatment were (38.3 ± 16.5),(39.1 ± 15.5),(35.3 ± 20.6) U/L respectively,higher than that before treatment((28.5 ± 8.8) U/L,P ＜ 0.05 or 0.01),and it was back to normal at 4th weeks.(2) The levels of urinary cystatin C were (2.51 ± 1.45) mg/L,(3.05 ± 1.13) mg/L,(2.46 ± 1.21) mg/L at 2nd,3th,4th weeks after treatment,significantly higher than that before treatment ((1.98 ±0.68) mg/L,P ＜0.05 or 0.01).And the levels of urinary β2 microglobulin at 2nd,3th,4th weeks after treatment were significantly higher than that before treatment (P ＜0.05 or 0.01) and back to normal at 5 weeks after treatment.(3) Nine cases at remission stage showed the symptoms of palpitation,precordial discomfort and increased heart rate,and all those symptoms were mild.And the symptoms disappear at the 3th week after the treatment.Creatine kinase at the 2nd weeks after treatment was (90.2 ± 32.5) U/L,higher than that before treatment ((78.5 ± 22.3) U/L).The levels of creatine kinase isoenzyme at 2nd,3th weeks after treatment were (8.3 ± 4.8) U/L,(8.5 ± 5.6) U/L,higher than that before treatment ((6.3 ± 3.5) U/L).The serum creatine kinase mass at 4th weeks((3.9 ±2.0) g/L) was significantly higher than that before treatment ((2.8 ± 1.9) g/L),and then gradually be back to normal.Conclusion The routine dose As2O3 in treatment of APL children show less toxicity in liver,kidney,and heart Those adverse effects are transient,reversible and they occurred at 1-3 week after As2O3 treatment.Serum alanine aminotransferase,aspartate aminotransferase and urinary cystine protease inhibitors,β2 micro ring protein and serum creatine kinase MB mass might be served as sensitive indicators of organ damage.
