柔红霉素联合阿糖胞苷治疗小儿急性白血病的临床疗效及对外周血调节性T细胞的影响

目的柔红霉素联合阿糖胞苷治疗小儿急性白血病的临床疗效及对外周血调节性T细胞(Treg)的影响。方法随机数字表法将78例急性白血病患儿分为观察组和对照组,每组39例。对照组患儿接受长春新碱+环磷酰胺+泼尼松治疗,观察组患儿接受柔红霉素+阿糖胞苷(DA方案)治疗。治疗1个月后评估两组患儿的近期疗效及化疗期间不良反应的发生情况;化疗前、化疗后、化疗后随访1个月,比较两组患儿外周血免疫功能指标,包括CD4+CD25+CD127-、NK细胞及T淋巴细胞亚群(CD3+、CD4+、CD8+)水平。结果观察组患儿临床总有效率为82.05%,高于对照组患儿的61.54%,差异有统计学意义(χ2=4.052,P﹤0.05)。化疗后,两组患儿CD3+、CD4+、NK细胞水平均低于本组化疗前,CD8+、CD4+CD25+CD127-水平均高于本组化疗前,差异均有统计学意义(P﹤0.05);观察组患儿CD3+、CD4+、NK细胞水平均高于对照组患儿,CD8+、CD4+CD25+CD127-水平均低于对照组患儿,差异均有统计学意义(P﹤0.05)。随访1个月,观察组患儿CD3+、CD4+、CD8+、NK细胞、CD4+CD25+CD127-水平均逐渐恢复至化疗前水平,与化疗前比较差异均无统计学意义(P﹥0.05)。观察组患儿化疗期间不良反应总发生率为35.90%,与对照组患儿的20.51%比较,差异无统计学意义(P﹥0.05)。结论红霉素联合阿糖胞苷治疗小儿急性白血病的近期疗效较好,可在一定程度上缓解CD4+CD25+Treg细胞介导的肿瘤免疫逃逸,安全性较高。

The clinical effects of daunorubicin combined with cytarabine in children with acute leukemia and the influence on regulatory T cells in peripheral blood

Objective To investigate the clinical effect of daunorubicin combined with cytarabine in the treatment of children with acute leukemia,and to determine the influence on regulatory T cells(Treg)in peripheral blood.Method Seventy-eight children with acute leukemia were categorized into study group or control group,with 39 cases in each.The control group was treated with vincristine+cyclophosphamide+prednisone,while the study group was administered with daunorubicin+cytarabine(DA regimen).One month after treatment,the short-term efficacy was evaluated,and the adverse reactions in both groups were assessed;before chemotherapy,after chemotherapy,and during 1-month follow-up after chemotherapy,the immune function indicators in peripheral blood,including CD4+CD25+CD127-,NK cells and T lymphocyte subsets(CD3+,CD4+,CD8+)were compared between the two groups.Result The overall response rate of the study group was 82.05%,which was significantly higher than that of the control group at 61.54%,the difference was of statistical significance(χ2=4.052,P<0.05).After chemotherapy,the levels of CD3+,CD4+and NK cells in the two groups decreased significantly,while CD8+,CD4+CD25+CD127-elevated markedly(P<0.05);the levels of CD3+,CD4+,and NK cells in study group were significantly higher than those in control group,and the levels of CD8+,CD4+CD25+CD127-levels were notably lower compared to control group after chemotherapy(P<0.05).After 1 month of follow-up,the levels of CD3+,CD4+,CD8+,NK cells,CD4+CD25+CD127-recovered to baseline in study group,indicating no significant difference from that before chemotherapy(P>0.05).The incidence of overall adverse reactions was 35.90%in study group during chemotherapy,with similar results observed in control group at 20.51%,only numerical difference was observed(P>0.05).Conclusion DA regimen is effective in terms of short-term improvement for the treatment of acute leukemia in children,with modest reduction on tumor immune escape mediated by CD4+CD25+Treg cells,while confers high safety.