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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。
Objective: To observe the therapeutic response of two commonly used forms of L-asparaginase in combination chemotherapy in children with acute lymphoblastic leukemia. Methods: The hospital from March 2010 to October 2010 vincristine + pirarubicin + asparaginase + prednisone chemotherapy in children with acute lymphoblastic leukemia, using pegylated L-asparaginase dosage form Aspergillus or VDPAP as group A (40 cases) and the past use of E. coli containing dosage forms or VDLP B group (60 cases) compared to observe the adverse reactions. Chemotherapy before and after the detection of blood, liver function, coagulation, allergy observed, etc., recorded after 28 days of chemotherapy indicators. Results: A group of allergy occurred in 2 cases (5%) and group B allergy occurred in 13 cases (21.67%), P value of 0.045, with statistical significance. In the past, 13 children who were allergic to Escherichia coli had no allergy to PEG-Asp and 2 had skin test-positive on the second dose. A group (> 2) leukopenia in 16 cases, neutropenia in 26 cases, hemoglobin decreased in 0 cases, thrombocytopenia in 5 cases, decreased fibrinogen in 1 case, partial thromboplastin time extension in 0 cases; B group (> Grade 2), there were 28 cases of leukopenia, 46 cases of neutropenia, 2 cases of hemoglobin decrease, 16 cases of thrombocytopenia, 2 cases of fibrinogen decrease and 0 cases of partial thromboplastin time extension. In group A, the antithrombin Ⅲ decreased in 23 cases, the D dimer increased in 4 cases, and the alanine aminotransferase increased in 5 cases. In group B (unfractionated) antithrombin Ⅲ decreased in 33 cases and D dimerization Elevated body in 8 cases, elevated alanine aminotransferase in 5 cases. There was no significant difference in hematological adverse reactions. The average length of stay in group A was 11.14 days. Group B average length of stay 18.47 days. CONCLUSION: The two formulations of L-asparaginase have similar adverse reactions, but the advantages of using pemetretase with fewer times of use, convenience of use, low rate of allergy and shortening of hospitalization days.