三氧化二砷联合全反式维甲酸诱导治疗儿童急性早幼粒细胞白血病的临床研究

目的观察三氧化二砷(As2O3)联合全反式维甲酸(ATRA)诱导治疗儿童急性早幼粒细胞白血病(APL)能否提高疗效，及改善其毒副反应。方法2000年2月至2005年1月于北京大学人民医院儿科就诊的初治APL患儿12例,观察经As2O3和ATRA联合治疗后的缓解情况、凝血功能恢复及毒副反应等；并与1994~2000年入院的11例单用ATRA治疗的初治APL患儿作对照。结果(1)As2O3联合治疗组完全缓解率高于对照组，11例完全缓解(11/12)，缓解率为91.7%；对照组完全缓解8例，1例脑出血死亡，完全缓解率72.7%(8/11)。(2)联合治疗组凝血指标于治疗后(7.82±4.12)d恢复正常，对照组于治疗后(14.33±5.77)d恢复正常，差异具有显著统计学意义(P<0.01)。(3)联合治疗组胃肠道反应、肌肉疼痛、肝功异常发生率较对照组高，但都为轻度一过性改变；对照组肾功能异常、头痛发生率较高。(4)联合治疗组治疗后白细胞升高的峰值明显低于对照组，且白细胞增高持续时间亦较短。结论As2O3联合ATRA治疗具有更高的诱导缓解率；能较快地改善凝血功能；无严重的不可逆毒副反应发生。

The prevention and treatment of shoulder dystocia

AbstractObjectiveTo study whether arsenic trioxide combined with all trans retinoic acid could improve the effect of induction therapy for childhood acute promyelocytic leukemia (APL) and evaluate side effects of this regimen.MethodsTwelve untreated patients with APL in our department from February 2000 to January 2005 were included in this research.The effectiveness and side effects were evaluated after induction therapy with arsenic trioxide and all trans retinoic acid.Eleven APL patients from 1994 to January 2000 treated with all trans retinoic acid only were used as control.Results1.Eleven of 12 cases with combined therapy achieved complete remission (CR).The CR rate (91.7%) was significantly higher than that with retinoic acid treated alone (72.7%).2.The coagulation index of the patients in the group with combined therapy was normal in 7.82±4.12 days after therapy,the control was 14.33±5.77 days (P<0.01).3.Gastrointestinal side effects,pain of muscle and mild abnormal liver function were observed more often in the group with combined therapy but these adverse reactions were temporary.Headache and abnormal renal function occurred more often in the control group.4.The number of white blood cells after therapy was much higher in control group than in the group with combined therapy.ConclusionThe combined therapy shows higher CR rate and rapid recovery of coagulation function.No severe side effects occur.