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目的观察脱氧核苷酸钠治疗成骨肉瘤新辅助化疗后白细胞减少的疗效。方法选取42例II b期成骨肉瘤患者,行术前2个周期新辅助化疗,化疗药物剂量及顺序为异环磷酰胺(15 g/m2/3周),顺铂(120 mg/m2/2周)和多柔比星(90 mg/m2/2周),第2个化疗周期(B组)给予脱氧核苷酸钠(2.0 mg/kg)静脉滴注,连续使用7天,第1个化疗周期(A组)给予等量生理盐水连续静脉滴注7天。分别于化疗后第1、3、5、7、9和11天抽取外周血检测白细胞变化趋势,并选取骨髓抑制最明显时间点比较白细胞严重减少(<1×109/L)患者的分布情况。结果在异环磷酰胺化疗中,两组脱氧核苷酸钠疗效差异无统计学意义(p1、3、5、7、9和11天分别为:0.06、0.65、0.45、0.08、0.13和0.90)。脱氧核苷酸钠可有效治疗白细胞减少,顺铂化疗后第5天白细胞为:3.52±0.21比4.03±0.39,(P=0.00);第7天为:3.04±0.14比4.01±0.21,(P=0.00);第9天为:2.84±0.24比3.51±0.22,(P=0.00);第11天为:2.94±0.14比3.81±0.21,(P=0.00)。而对多柔比星,脱氧核苷酸钠不仅可缓解化疗后白细胞的减少趋势。化疗后第5天白细胞为:3.24±0.14比3.91±0.10(P=0.00);第7天为:2.13±0.14比3.91±0.21(P=0.00);第9天为:0.84±0.24比2.81±0.15(P=0.00);第11天为:0.75±0.15比3.10±0.11(P=0.00);还减少骨髓抑制高峰期严重白细胞减少患者的比例(4/38比36/6;6/36比39/3,P=0.00),降低预防性抗生素使用率,减少费用和并发症。结论脱氧核苷酸钠可有效治疗顺铂和多柔比星化疗后成骨肉瘤患者白细胞减少,而在异环磷酰胺化疗过程中未见明显疗效。
Objective To observe the effect of deoxynucleate sodium on leucopenia after neoadjuvant chemotherapy for osteosarcoma. Methods Forty - two patients with stage Ⅱ b osteosarcoma were enrolled in this study. Neoadjuvant chemotherapy was given in 2 cycles before operation. The dose and sequence of chemotherapy were ascitral cyclophosphamide (15 g / m2 / 3 weeks), cisplatin (120 mg / m2 / 2 weeks) and doxorubicin (90 mg / m2 / 2 weeks), and the second chemotherapy cycle (Group B) was given an intravenous drip of sodium deoxynucleotide (2.0 mg / kg) A chemotherapy cycle (group A) was given an equal volume of saline for 7 days. Peripheral blood leukocytes were collected on the 1st, 3rd, 5th, 7th, 9th and 11th day after chemotherapy, respectively. The distribution of leukocytes in patients with severe myelosuppression (<1 × 109 / L) at the most obvious time point of myelosuppression was selected. Results In ifosfamide chemotherapy, there was no significant difference in the efficacy of deoxynucleotide between the two groups (0.06, 0.65, 0.45, 0.08, 0.13 and 0.90 on p1,3,5,7,9 and 11 days, respectively) . On the fifth day after cisplatin chemotherapy, white blood cells were 3.52 ± 0.21 vs 4.03 ± 0.39 (P = 0.00); on the seventh day: 3.04 ± 0.14 vs 4.01 ± 0.21 (P = 0.00); Day 9 was: 2.84 ± 0.24 vs 3.51 ± 0.22 (P = 0.00); Day 11 was 2.94 ± 0.14 vs 3.81 ± 0.21 (P = 0.00). For doxorubicin, sodium deoxynucleotide can not only alleviate the trend of leukopenia after chemotherapy. On day 5 after chemotherapy, leukocytes were 3.24 ± 0.14 vs. 3.91 ± 0.10 (P = 0.00); on day 7: 2.13 ± 0.14 vs. 3.91 ± 0.21 (P = 0.00); on day 9: 0.84 ± 0.24 vs. 2.81 ± 0.15 (P = 0.00); Day 11: 0.75 ± 0.15 vs. 3.10 ± 0.11 (P = 0.00); and also decreased the proportion of patients with severe leucopenia at the peak of myelosuppression (4/38 vs 36/6; 6/36 ratio 39/3, P = 0.00), reducing the use of prophylactic antibiotics and reducing costs and complications. Conclusion Sodium deoxynucleotide can effectively treat leukopenia in patients with osteosarcoma after cisplatin and doxorubicin chemotherapy, but no significant effect in the course of chemotherapy with ifosfamide.