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目的探讨地西他滨联合高三尖杉酯碱+阿糖胞苷+重组人粒细胞集落刺激因子(小剂量HAG方案)在老年急性髓系白血病患者中的应用及新思路。方法选取2016年1月至10月间江苏省无锡市人民医院收治的68例老年急性髓系白血病患者,采用随机数表法分为观察组和对照组,每组34例。观察组患者采用地西他滨联合小剂量HAG方案化疗,对照组患者采用阿糖胞苷+阿克拉霉素+重组人粒细胞集落刺激因子(CAG方案)化疗。观察比较两组患者治疗后的疗效、CD4~+、CD8~+和CD4~+/CD8~+水平及不良反应。结果观察组患者总有效率为91.2%,高于对照组患者的67.6%,差异有统计学意义(P<0.05)。治疗前,两组患者CD4~+、CD8~+及CD4~+/CD8~+水平比较,差异无统计学意义(P>0.05)。治疗后,观察组患者的CD4~+和CD4~+/CD8~+水平高于对照组,CD8~+水平低于对照组,差异均有统计学意义(均P<0.05)。两组患者的不良反应为胃肠道反应、肝功能异常、呼吸感染和发热等,后经处理,症状缓解。两组患者各项不良发应发生率比较,差异无统计学意义(P>0.05)。结论地西他滨联合小剂量HAG在老年急性髓系白血病患者中的应用效果显著,安全性较高,值得临床推广。
Objective To investigate the application and the new ideas of decitabine combined with homoharringtonine + cytarabine + recombinant human granulocyte colony-stimulating factor (low dose HAG regimen) in elderly patients with acute myeloid leukemia. Methods Sixty-eight elderly patients with acute myeloid leukemia who were admitted to Wuxi People’s Hospital of Jiangsu Province from January to October 2016 were randomly divided into observation group and control group with 34 cases in each group. Patients in the observation group were treated with decitabine combined with low-dose HAG regimen, while patients in the control group were treated with cytarabine + aclacinomycin + recombinant human granulocyte colony-stimulating factor (CAG regimen) chemotherapy. The curative effect, CD4 ~ +, CD8 ~ + and CD4 ~ + / CD8 ~ + levels and adverse reactions in the two groups were observed and compared. Results The total effective rate in observation group was 91.2%, which was higher than that in control group (67.6%), the difference was statistically significant (P <0.05). Before treatment, there was no significant difference in CD4 ~ +, CD8 ~ + and CD4 ~ + / CD8 ~ + levels between the two groups (P> 0.05). After treatment, the levels of CD4 ~ + and CD4 ~ + / CD8 ~ + in the observation group were higher than those in the control group, and the levels of CD8 ~ + in the observation group were lower than those in the control group (all P <0.05). Adverse reactions to the two groups of patients with gastrointestinal reactions, abnormal liver function, respiratory infection and fever, after treatment, the symptoms ease. There was no significant difference between the two groups in incidence of adverse reactions (P> 0.05). Conclusion Decitabine combined with low-dose HAG in elderly patients with acute myeloid leukemia effect is significant, safe, worthy of clinical promotion.