| 蒋慧,曾庆曙,阮敏,等.骨髓增生异常综合征患者染色体核型及两种治疗方案的比较分析[J].安徽医药,2016,20(4):711-714. |
| 骨髓增生异常综合征患者染色体核型及两种治疗方案的比较分析 |
| Karyotype of patients with myelodysplastic syndromes and the comparative analysis of two treatment regimens |
| 投稿时间：2016-01-11 |
| DOI： |
| 中文关键词: 骨髓增生异常综合征 核型分析 地西他滨 去甲基化 疗效 |
| 英文关键词: myelodysplastic syndromes karyotyping decitabine demethylation efficacy 考文献: |
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| 中文摘要: |
| 目的 探讨骨髓增生异常综合征(myelodysplastic syndromes,MDS)患者的细胞遗传学特点及其对预后的影响,观察地西他滨3 d和5 d方案治疗骨髓增生异常综合征(MDS)的临床疗效及安全性。方法 回顾性分析48例MDS患者的临床资料,探讨所有患者的染色体核型与预后的关系。观察比较两组方案各完成2个疗程治疗的MDS患者的疗效与不良反应。其中3 d方案患者20例,地西他滨每天45 mg·m-2,QD,静脉滴注,连用3 d,28 d为一个疗程。5 d方案患者28例,地西他滨每天20 mg·m-2,QD,静脉滴注,连用5 d,28 d为一个疗程。结果 48例患者中20例检出异常染色体核型,占所有患者的41.67%,其中难治性贫血伴原始细胞增多1型及2型异常染色体核型检出率较高。据IPSS-R积分系统分组,危险分层越高,异常染色体核型检出率越高(P<0.05),转化为急性白血病的概率越高。3 d方案组总反应率为30%,5 d方案组总反应率为46.43%,差异无统计学意义(P>0.05)。不良反应主要表现为骨髓抑制、感染、出血,其中3 d方案组和5 d方案组比较,差异有统计学意义(P＜0.05),前者均高于后者。结论 染色体核型分析对MDS的诊断及预后判断具有重要价值。5 d方案较3 d方案治疗MDS具有相似的有效率,但其具有明显较低的不良反应发生率,5 d方案更值得推广。 |
| 英文摘要: |
| Objective To investigate the relationship between cytogenetic markers and prognosis in cases with primary myelodysplastic syndromes(MDS). To observe the clinical safety and efficacy of decitabine in the 3-day regimen and the 5-day regimen for patients with myelodysplastic syndromes(MDS). Methods The clinical data of 48 patients (3 day 20,5 day 28) with MDS were retrospectively analyzed. The relationship between karyotype and prognosis was analyzed. The adverse effect and efficacy of the two regimens were observed and compared. Results Twenty-one out of 48 patients (41.67%) showed karyotypic abnormalities. The rates of abnormal karyotype in RAEB-1, RAEB-2 were much higher than others MDS. An analysis based on IPSS-R Scoring System showed that advanced risk stratification gradually enhanced the incidence of karyotypic abnormalities (P<0.05). In addition, the probability of evolution to leukemia increased with the higher IPSS-R score (P<0.05). There was no significant difference between the two regimens in the overall response rates (3 day 30% vs 5 day 46.43%, P＞0.05). Adverse events including myelosuppression,infection and bleeding were mainly caused by decitabine, and the incidences of adverse effect in 5-day regimen were significantly lower than 3-day regimen (P＜0.05). Conclusion Karyotype analysis has a great value for the diagnosis and prognosis of MDS. The efficacy of 3-day regimen and 5-day regimen was similar, and the incidences of adverse effect in 3-day regimen were significantly higher than 5-day regimen, which is valuable for popularization. |
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