Effect of modified Hyper-CVAD therapy on elderly patients with pH negative acute lymphoblastic leukemia secondary hyperglycemia
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摘要:
目的 探讨改良Hyper-CVAD方案对中老年pH阴性急性淋巴细胞白血病血糖的影响，并探索血糖与预后的关系。 方法 随机选择72例中老年pH阴性急性淋巴细胞性白血病患者并分为A、B组，各36人。A组给予改良Hyper-CVAD方案诱导化疗，B组给予常规Hyper-CVAD方案治疗，比较化疗前后两组患者的临床特征、继发高血糖的情况及化疗后生存状况，并对患者进行为期3年的随访。 结果 对照组第3周末的随机血糖高于观察组（8.03±2.73 mmol/L vs 7.85±2.54 mmol/L），且高于对照组自身第1周末的随机血糖（8.03±2.73 mmol/L vs 7.37±2.19 mmol/L, P<0.05）；第4周末两组患者的空腹及随机血糖均高于自身第1周末，且对照组随机血糖显著高于观察组（8.57±3.32 mmol/L vs 8.03±2.59 mmol/L,P<0.05），但两组空腹血糖差异无统计学意义（P>0.05）。对照组继发高血糖比例为22.22%，显著高于观察组的5.56%（P<0.05），但两组复发率、生存率差异无统计学意义。两组第4周末空腹及随机血糖均与感染、缓解率、复发率及总生存率呈相关性。两组分别有11、14例出现复发，但其复发率差异无统计学意义（30.56% vs 38.89%，P=0.458）；两组分别有9、12例患者死亡，生存率差异无统计学意义（75.00% vs 67.67%，P=0.437）。 结论 改良Hyper-CVAD方案可有效降低中老年Ph阴性急性淋巴细胞白血病并发继发性高血糖的几率。 -
关键词:
- 改良Hyper-CVAD /
- 中老年 /
- pH阴性 /
- 急性淋巴细胞白血病 /
- 高血糖
Abstract:Objective To investigate the effect of modified Hyper-CVAD therapy on elderly patients with pH negative acute lymphoblastic leukemia (ALL) secondary hyperglycemia and explore the relation between prognosis and hyperglycemia. Methods Seventy-two elderly patients (≥55) with pH -negative ALL were enrolled in the study. The patients were randomly divided into 2 groups with 36 patients in each group. Patients in group A were performed with improved Hyper-CVAD therapy. Group B were performed with routine Hyper-CVAD therapy. The clinical features, secondary hyperglycemia and the survival status after chemotherapy were compared between the two groups before and after chemotherapy. The patients were followed up for 3 years. Results The random blood sugar of control group on the third weekend was higher than that of the observation group, and higher than that of the first weekend in control group (P<0.05). Fasting blood glucose and blood glucose were higher on the fourth weekend in the two groups than that in the first weekend (P<0.05). The random blood sugar in control group was significantly higher than that in observation group (P<0.05). There was no significant difference of fasting blood glucose between the two groups (P<0.05). The proportion of secondary hyperglycemia in control group was 22.22%, which is significantly higher than that of observation group(5.56%). There was no significant difference of recurrence rate and survival rate between the two groups. Fasting and random blood glucose on the fourth week of the two groups were correlated with infection, remission rate, relapse rate and overall survival rate.There were 11 and 14 cases recurred respectively in the two groups, with no significant difference (30.56% vs 38.89%, P=0.458). Nine cases and 12 patients died respectively in the two groups, with no significant difference(75.00% vs 67.67%, P=0.437). Conclusion The improved Hyper-CVAD therapy can effectively reduce the risk of secondary hyperglycemia induced by chemotherapy on elderly patients with Ph-negative acute lymphoblastic leukemia. -
Key words:
- improved Hyper-CVAD /
- aged patients /
- pH negative /
- acute lymphocytic leukemia hyperglycaemia /
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表 1 两组患者一般资料比较（n=36，
$\bar x \pm s$ ）分组 性别（男/女） 年龄（岁） 病程（月） 初诊白细胞计数（G/L） 骨髓免疫分型（T细胞系/B细胞系） 染色体畸变（有/无） BCR/ABL融合基因（有/无） 观察组 21/15 61.32±9.56 5.36±3.02 25.93±18.23 7/29 32/4 33/3 对照组 23/13 60.18±10.02 5.84±2.97 26.38±20.12 6/30 30/6 31/5 χ2/t 0.234 1.132 –0.893 –0.642 0.094 0.465 0.563 P 0.629 0.125 0.964 1.027 0.759 0.496 0.453 
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表 2 两组患者血糖代谢基线水平比较（n=36，
$\bar x \pm s$ ）分组 空腹血糖（mmol/L） 随机血糖（mmol/L） 糖化血红蛋白（%） 观察组 4.94±1.13 7.28±2.31 5.34±1.26 对照组 4.82±1.06 7.13±2.12 5.19±1.13 t 0.782 0.841 0.824 P 0.104 0.913 0.871
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表 3 两组不同时间点的血糖水平比较（mmol/L，
$\bar x \pm s$ ，n=36）分组 测量时机 第1周末 第2周末 第3周末 第4周末 观察组 空腹 4.85±1.21 5.02±1.32 5.14±1.45 5.37±1.65# 随机 7.31±2.12 7.63±2.32 7.85±2.54 8.03±2.59# 对照组 空腹 4.93±1.17 5.11±1.45 5.33±1.56 5.84±1.93 随机 7.37±2.19 7.74±2.49 8.03±2.73*# 8.57±3.32*# *P<0.05 vs 观察组; #P<0.05 vs 第1周末.
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表 4 两组患者高血糖及复发例数与生存情况（n=36）
分组 继发高血糖（n） 复发例数（n，%） 3年生存率（%） 观察组 2 11（30.56%） 75.00 对照组 8 14（38.89%） 67.67 t/χ2 4.181 0.551 0.605 P 0.041 0.458 0.437
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表 5 第4周末血糖水平与预后的相关性分析
指标 感染发生率 完全缓解率 累积复发率 总生存率 r P r P r P r P 第4周末空腹血糖水平 0.764 0.032 0.783 0.026 0.741 0.036 0.832 0.009 第4周末随机血糖水平 0.813 0.014 0.822 0.011 0.753 0.022 0.845 0.003
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