L-ASP治疗儿童急性淋巴细胞白血病副作用观察(附171例临床报告)

目的:探讨左旋门冬酰胺酶(L-asparaginase,L-ASP)在儿童急性淋巴细胞白血病联合化疗时的严重毒副作用及与临床分型和各化疗阶段的关系,以便针对性地进行预防。方法:对171例儿童急性淋巴细胞白血病(AcuteLymphoblasticLeukemia,ALL)应用左旋门冬酰胺酶后的临床表现、血液生化检查进行分析。结果:171例中发生副作用26例(15·2%),其中凝血功能异常9例(5·3%),急性过敏反应6例(3·5%),胰腺损害5例(2·3%),低蛋白血症3例(1·8%),肝功能损害3例(1·8%)。用确切概率法及X2检验对这几种副作用发生率与临床分型关系进行统计,结果P均大于0·05,无统计学意义。化疗不同阶段副作用的发生率比较,早期强化阶段占优势。结论:L-ASP引起的副作用与临床分型无关,可能与化疗不同阶段有关,主要发生在早期强化阶段。用药前及期间、之后要定期测血糖、尿糖、血尿淀粉酶、肝功和及时对症治疗,并加强饮食控制,能有效控制副作用严重程度,并防止糖尿病等某些毒副作用的发生。

The Clinical Study of the Toxicity from L-asparaginase in Treating Childhood Acute Lymphoblastic Leukemia

Objective:To observe the toxicity from L-asparaginase in treating childhood ALL and study their relation with the cilinical types of ALL and the different chemotherapy phases.Methods:171 cases ALL were treated with VDLP protocol.Their amylase and glucose in blood and urine and their function of liver and,renal function were inspected regularly.Results:Among 171 cases 9 cases present with coagulation disorders ( 5.3%),6 cases with hypersensitiveness (3.5%),5 cases with toxicity on pancrease (2.3% ),3 cases with hypoproteinemia ( 1.8%),3 cases with the damage of the liver.( 1.8%).When comparing the incidence of side effects of L-ASP with the clinical types of ALL by the Microsoft SPSS,it has no statistical significance,P>0.05.Conclusion:The side effects from L-ASP may be no correlation with the clinical types of ALL,But it seems correlate with the different chemotherapy phases.It could be controled effectively to measure amylase and glucose in blood and urine and their function of liver and kidney,give approperate treatment and control their diet at the same time before,after and during acceptting chemotherapy.