培门冬酶治疗儿童急性淋巴细胞性白血病的不良反应观察

目的：观察左旋门冬酰胺酶两种常用剂型在急性淋巴细胞性白血病患儿联合化疗中的治疗反应。方法：本院2010.3-2010.12行长春新碱＋吡柔比星＋门冬酰胺酶＋强的松方案化疗的急性淋巴细胞白血病患儿,使用含有聚乙二醇化的左旋门冬酰胺酶剂型培门冬酶即VDPAP者作为A组（40例）与既往使用含大肠杆菌剂型即VDLP者B组（60例）对比,观察不良反应。化疗前后检测血象,肝功能,凝血功能,观察过敏情况等,记录化疗后第28天的各项指标。结果：A组过敏发生2例（5%）而B组过敏发生13例（21.67%）,P值0.045,有统计学意义。既往对大肠杆菌剂型发生过敏的13例患儿首剂使用PEG-Asp均无过敏,2例于第二剂时出现皮试阳性。A组（〉2级）白细胞减少16例,中性粒细胞减少26例,血红蛋白降低0例,血小板减少5例,纤维蛋白原降低1例,部分凝血活酶时间延长0例;B组（〉2级）白细胞减少28例,中性粒细胞减少46例,血红蛋白降低2例,血小板减少16例,纤维蛋白原降低2例,部分凝血活酶时间延长0例。A组（未分级）抗凝血酶Ⅲ降低23例,D二聚体升高4例,谷丙转氨酶升高5例;B组（未分级）抗凝血酶Ⅲ降低33例,D二聚体升高8例,谷丙转氨酶升高5例。.血液学不良反应差异无统计学意义。A组平均住院日11.14天。B组平均住院日18.47天。结论：左旋门冬酰胺酶两种剂型不良反应相当,但培门冬酶具有使用次数少,使用方便,过敏率低,缩短住院日的优点。

Adverse Reactions of Pegaspargase for Acute Lymphocytic Leukemia

Objective： To investigate the adverse reactions of the two common dosage forms of L-asparagine enzyme in the combi-nation chemotherapy of acute lymphocytic leukemia.Methods： During January 2009 to December 2010,the children with acute lympho-cytic leukemia received the chemotherapy concluding Vincristine,Pirarubicin,Asparaginase and Prednisone.The patients using pegas-pargase which was the pegylation of L-asparaginase in VDPAP project were chosen as A group（40 cases）,while the patients who using L-asparaginase in the past were chosen as B group（60 cases）.The adverse reactions were detected.During the anterior-posterior combi-nation chemotheray,the hemogram,blood clotting function and the allergy were detected in the twenty-eighth day.Results： The allergy occurred in 2 patients in group A（5%） and 13 cases of allergy in group B（21.67%）,P=0.045,which was statistically significant.The rest adverse reactions,including Leukopenia,neutropenia,thrombocytopenia,hypohemoglobinemia,hypoinosis,the extension of partial thromboplastin time,the reduction of antithrombin Ⅲ,and the rise of alanine aminotransferase,hypoproteinemia,had no significant dif-ferences.The average hospital stay of the patients in the Group A is 11.14 days while in the Group B is 18.47 days.Conclusion： There is not much difference in adverse reactions of the two formulations of L-asparaginase,but pegaspargase has the following advantages： less frequency of use,easy to use,low allergy,reducing the hospital stay.