张慧琪 杨宇佳

[摘要] 目的 探討急性早幼粒细胞白血病患者采用三氧化二砷联合全反式维甲酸治疗的效果。 方法 选取本院2012年10月～2014年10月收治的急性早幼粒细胞白血病患者60例，根据随机数表法分为两组，各30例。对照组患者单纯接受化疗治疗，并将化疗治疗与全反式维甲酸交替实施；观察组患者则在对照组基础上联合使用三氧化二砷。对比两组患者治疗完全缓解率、早期死亡率、复发率及第1年、第2年、第3年的总生存率，同时记录两组患者在接受药物治疗期间发生的头痛、轻度皮肤黏膜干燥、消化道症状、心肌缺血等不良反应。 结果 两组患者早期死亡率比较，差异无统计学意义（P>0.05）；观察组完全缓解率高于对照组，复发率低于对照组，平均完全缓解时间较对照组短，差异有统计学意义（P<0.05）；两组患者第1年、第2年、第3年总生存率比较，差异均无统计学意义（P>0.05）；两组患者药物治疗期间头痛、轻度皮肤黏膜干燥、消化道症状、心肌缺血等不良反应发生率比较，差异无统计学意义（P>0.05）。 结论 急性早幼粒细胞白血病患者在接受常规化疗及全反式维甲酸药物治疗基础上联合使用三氧化二砷疗效确切，患者治疗后各临床症状及体征得到更好更快缓解，完全缓解率高，复发风险明显降低，且不会增加患者消化道症状、心肌缺血等不良反应的发生，安全性理想。

[关键词] 急性早幼粒细胞白血病；三氧化二砷；全反式维甲酸；不良反应

[中图分类号] R733.7 [文献标识码] B [文章编号] 1673-9701（2018）25-0105-04

[Abstract] Objective To investigate the effect of arsenic trioxide combined with all-trans retinoic acid in the treatment of the patients with acute promyelocytic leukemia. Methods 60 patients with acute promyelocytic leukemia who were admitted to our hospital from October 2012 to October 2014 were selected. According to the random number table method， they were divided into two groups， with 30 cases in each group. The control group was given chemotherapy alone， and the chemotherapy and all-trans retinoic acid were given alternately. The patients in the observation group were given arsenic trioxide in combination with the control group. The complete remission rate， early mortality rate， recurrence rate， and overall survival rate in the first， second， and third years were compared between the two groups. At the same time， the adverse reactions such as headache， mild skin mucous membrane dryness， gastrointestinal symptoms， and myocardial ischemia occurring during the drug treatment were recorded in the two groups of patients. Results There was no statistically significant difference in the early mortality rate between the two groups（P>0.05）； the complete remission rate was higher in the observation group than that in the control group， and the relapse rate was lower than that in the control group. The average time of complete remission was shorter than that in the control group， and the difference was statistically significant（P<0.05）； there was no statistically significant difference in the overall survival rate in the first， second and third year in the two groups（P>0.05）； there was no statistically significant difference in the incidence rate of adverse reactions such as headache， mild skin mucous membrane dryness， gastrointestinal symptoms， and myocardial ischemia during the drug treatment period between the two groups（P>0.05）. Conclusion The application of arsenic trioxide in combination with conventional chemotherapy and all-trans retinoic acid drug treatment is effective in the patients with acute promyelocytic leukemia. After treatment， the clinical symptoms and signs can be remitted in a better and faster manner in the patients， the complete remission rate is high， and the risk of recurrence is significantly reduced. Also， it does not increase patients' gastrointestinal symptoms， myocardial ischemia and other adverse reactions. The safety is ideal.

[Key words] Acute promyelocytic leukemia； Arsenic trioxide； All-trans retinoic acid； Adverse reactions

急性早幼粒细胞白血病（Acute promyeloctic leuke-mia，APL）是一种特殊的急性髓系白血病，在全部APL患者中有95%的患者具有特征性细胞遗传学改变，即维甲酸受体α（PML-RARα）融合基因及染色体异位[1]。近年……