摘要
目的了解长期口服四硫化四砷(As_4S_4)对急性早幼粒细胞白血病(APL)患者肝脏的慢性毒性。方法对长期服用 As_4S_4的 APL 患者各时期生化指标、超声检查结果(包括肝、脾大小形态,实质回声及门脉宽度的检查)及肝纤维化指标(PⅢNP 及Ⅳ型胶原)进行跟踪分析。结果 106例服用 As_4S_4的 APL 患者,中位随访时间为36(6～72)个月,丙肝阴性组84例,初始服用时,丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)高于2倍正常值的发生率分别为16.7%和15.5%.ALT、AST、γ-谷氨酰转移酶(GGT)水平比服药前有明显升高(P 值均<0.05),连续用药0.5,1.0,2.0,3.0年及3.0年以上 ALT、AST、GGT 水平与用药前相比差异无统计学意义(P 值均>0.05),其他生化指标:碱性磷酸酶(ALP)、乳酸脱氧酶(LDH)、总胆红素(TBIL)、直接胆红素(DBIL)、总蛋白(TP)、白蛋白(ALB)、白蛋白与球蛋白比值(A/G)、尿素氮(BUN)、肌酐(CRE)与用药前相比差异均无统计学意义(P 值均>0.05);丙肝阳性组22例,初始服用时 ALT、AST 高于2倍正常值的发生率分别为63.6%和59.1%,连续用药2年后肝功能恢复至接近正常水平。连续用药3年以上的 APL 患者42例,丙肝阴性组33例患者中,2例睥肿大、1例门脉增宽,21例(63.6%)被诊断为脂肪肝,16例进行肝纤维化指标检测均为正常;丙肝阳性组9例患者中,4例脾肿大,2例门脉增宽,6例(66.7%)被诊断为脂肪肝,6例进行肝纤维化指标检测,2例高于正常值。结论 APL 患者长期服用 As_4S_4对肝功能无显著影响,未引起明显的肝纤维化和门脉高压症状,但脂肪肝发病率较高,应长期随访。
Objective To investigate the chronic hepatic damage in acute promyelocytic leukemia （APL） patients long-term treated with tetra-arsonic tetra-sulfide（As4S4 ）. Methods The periodical liver biochemical examinations and uhrasonography results and hepatic fibrosis indicators（ PⅢ NP and type Ⅳ collagen） of patients were analysed, Results 106 APL patients treated with As4S4 ,the median follow-up time was 36 months（6 - 72）. The HCV（ - ）group includes 84 APL patients. During the first course the abnomal rate of the alanine aminotransferase（ALT） and asparate aminotransferase（AST） was 16.7% and 14.5% （ higher than the two times of the nomal value）, the ALT ,AST γ-glyoxylate aminotransferase（GGT） levels during the first course were statistically higher than As4S4 treatment before （ P 〈 0.05）. There were no statistically differences between the ALT,AST,GGT levels after and before treating with As4S4 in half a year,one year,two year,more than three years （P 〉 0.05 ）. Other biochemical indicators such as ALP, LDH,TBIL, DBIL,TP, ALB,A/G,BUN ,CRE, there were no siganificantly differences before and after As4S4 treatment （P 〉 0.05 ）. The HCV（ ＋ ）group includes 22 APL patients,during the first course,the abnomal rate of the ALT,AST were 63.6% and 59.1% , but at the 2 year ,more than 3 years there were no siganificantly differences compared with As4S4 treatment before（ P 〉0.05）. 42 APL patients were treated with As4S4 more than 3 years , in 33 HCV （ - ）APL patients, two APL patients had splenomegaly,one APL patient, s breadth of the portal vein was wider than 1.4cm,21 APL patients had fatty liver （63.6%）. The hepatic fibrosis indicators of the 16 APL patients were all nomal. In 9 HCV （ ＋ ） APL patients, 4 APL patients had splenomegaly,2 APL patients, breadth of portal vein were wider than 1.4 cm ,6 APL patients had fatty liver（66.7 % ）. 6 patients were examined with the hepatic fibrosis indicators,2 patients, were higher than the nomal value. C
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2006年第4期259-263,共5页
Chinese Journal of Hematology
关键词
砷剂
白血病
早幼粒细胞
急性
药物毒性
肝
Arsenicals
Leukemia, promyelocytie,acute
Drug toxicity, liver
