2020 年第 2 期 第 15 卷

慢性髓性白血病的临床特征及治疗分析

Clinical characteristics and treatment of chronic myeloid leukemia

作者：李泽慧葛晓燕

英文作者：

单位：山西医科大学第二医院血液科，太原030001

英文单位：

关键词：慢性髓性白血病；酪氨酸激酶抑制剂；伊马替尼；尼洛替尼；达沙替尼

英文关键词：

• 摘要：

• 【摘要】目的    探讨慢性髓性白血病（CML）患者的临床特征及酪氨酸激酶抑制剂（TKI）药物的选择和疗效。 方法收集2013年1月至2018年7月在山西医科大学第二医院血液科住院的334例CML患者病历资料，男186例，女148例。回顾性分析全部CML患者的血常规、血清生化检测（肝肾功能等）、T细胞亚群测定和骨髓穿刺涂片检查结果。进行常规染色体核型分析、荧光原位杂交、9号染色体的ABL（BCR-ABL）基因突变分析、腹部彩色多普勒超声等，做预后随访。比较3种TKI药物伊马替尼、尼洛替尼、达沙替尼对CML的疗效。结果    334例患者中位年龄为42（21～82）岁，其中慢性期158例（47.3%），加速期70例（21.0%），急变期106例（31.7%）。Ph染色体的阳性率为85.0%（284/334）。中性粒细胞碱性磷酸酶（NAP）积分减低者为71.3%（238/334）。BCR-ABL基因定量检测在慢性期、加速期、急变期的中位数分别为0.006 6（0～69.8）、1.5（0.034～52.2）、2.6（0～253.7）。慢性期和加速期时，尼洛替尼和达沙替尼的有效率高于伊马替尼，急变期伊马替尼有效率高。结论    对于CML患者，需要定期检测染色体、BCR-ABL mRNA水平、NAP等，这对于评估疾病发展具有重要的意义。当患者确诊为CML时，应尽早使用TKI，可根据患者是否存在基因突变，选择不同的TKI。

• 【Abstract】Objective    To investigate the clinical features, drug choice of tyrosine kinase inhibitor(TKI) and the therapeutic efficacy in patients with chronic myeloid leukemia(CML). Methods    Clinical data of 334 CML patients（186 males and 148 females） hospitalized in the Second Affiliated Hospital of Shanxi Medical University from January 2013 to July 2018 were retrospectively analyzed. Blood routine and biochemical tests(hepatic and renal function）, T cell subsets, bone marrow biopsy results, gene and chromosome mutation ［karyotype, fluorescence in situ hybridization, ABL of chromosome 9（BCR-ABL）］, abdominal color Doppler ultrasonography findings and the effects of 3 kinds of TKI(imatinib, nilotinib, dasatinib) on CML were analyzed. Results    The median age of 334 patients was 42(21-82)years. There were 158 cases(47.3%) of chronic phase, 70 cases(21.0%) of accelerated phase and 106 cases(31.7%) of blast phase. Ph chromosome positive rate was 85.0%(284/334). Rate of neutrophil alkaline phosphatase(NAP) score reduction was 71.3%(238/334). The median quantities of BCR-ABL gene test at chronic phase, accelerated phase and blast phase were 0.006 6(0-69.8), 1.5(0.034-52.2) and 2.6(0-253.7), respectively. Nilotinib and dasatinib showed higher effectiveness than imatinib at chronic and accelerated phases; imatinib was more effective at blast phase. Conclusions    Regular detections of chromosomes, BCR-ABL mRNA and NAP are important in assessing disease progression of CML. TKI should be used according to the gene mutation type.