[1]周倩,张欣雨,隋美娟.全反式维甲酸和三氧化二砷诱导治疗初发急性早幼粒细胞白血病患者肝损害风险分析[J].陕西医学杂志,2026,(7):952-957.[doi:DOI:10.3969/j.issn.1000-7377.2026.07.014]
 ZHOU Qian,ZHANG Xinyu,SUI Meijuan.Risk analysis of hepatotoxicity induced by all-Trans retinoic acid and arsenic trioxidein the treatment of newly diagnosed acute promyelocytic leukemia patients[J].,2026,(7):952-957.[doi:DOI:10.3969/j.issn.1000-7377.2026.07.014]
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全反式维甲酸和三氧化二砷诱导治疗初发急性早幼粒细胞白血病患者肝损害风险分析

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2026年7期
页码:
952-957
栏目:
药物与临床
出版日期:
2026-07-05

文章信息/Info

Title:
Risk analysis of hepatotoxicity induced by all-Trans retinoic acid and arsenic trioxidein the treatment of newly diagnosed acute promyelocytic leukemia patients
作者:
周倩1张欣雨2隋美娟3
(1.内蒙古自治区人民医院血液内科,内蒙古 呼和浩特010017;2.内蒙古医科大学,内蒙古 呼和浩特010110;3.哈尔滨医科大学附属第一临床医学院血液肿瘤中心实验室,黑龙江 哈尔滨 150001)
Author(s):
ZHOU Qian1ZHANG Xinyu2SUI Meijuan3
(1.Department of hematology,Inner Mongolia People’s Hospital,Hohhot 010017,China;2.Inner Mongolia Medical University,Hohhot 010110,China;3. Laboratory of Hematology and Oncology,The First Clinical Medical College of Harbin Medical University,Harbin 150001
关键词:
急性早幼粒细胞白血病全反式维甲酸三氧化二砷诱导治疗肝损害初诊
Keywords:
Acute promyelocytic leukemiaAll-trans retinoic acidArsenic trioxideInduction therapyHepatotoxicityNewly diagnosed
分类号:
R 575
DOI:
DOI:10.3969/j.issn.1000-7377.2026.07.014
文献标志码:
A
摘要:
目的:探讨全反式维甲酸(ATRA)联合三氧化二砷(ATO)双诱导方案与ATRA单药、ATO单药方案治疗初发急性早幼粒细胞白血病(APL)的临床疗效及肝损害特征,为临床治疗优化提供依据。方法:选取82例初治APL患者,按治疗方案分为双诱导组(44例,ATRA+ATO)、ATRA单药组(19例)、ATO单药组(19例),比较三组完全缓解率、完全缓解时间及肝功能指标异常情况。结果:双诱导组完全缓解时间(24.38 d)显著短于ATRA单药组(31.26 d)和ATO单药组(29.72 d)(均P<0.05),三组完全缓解率比较无统计学差异(97.72%、94.74%、94.74%,均P>0.05)。双诱导组肝损害发生率(68.18%)显著高于ATRA单药组(42.11%)和ATO单药组(47.37%),肝损害患者中Ⅲ-Ⅳ度肝损害比例为:双诱导组(63.33%)远高于两单药组(25.00%、33.33%,均P>0.05),双诱导组丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)异常率及,ALT、AST峰值也显著更高(均P<0.05),ALT、AST、GGT峰值出现时间比较三组无统计学差异(均P>0.05),三组ALP、总胆红素异常率比较无统计学差异(均P>0.05)。ATRA单药组与ATO单药组肝毒性特征比较无统计学差异(P>0.05)。所有肝损害患者经规范干预后均恢复正常(中位恢复时间14 d),无相关死亡;相关性分析显示,肝损害程度较重者完全缓解时间呈缩短趋势(r=-0.236,P=0.032);中位随访18个月无复发病例。结论:ATRA联合ATO双诱导方案治疗初发APL疗效确切,可显著缩短完全缓解时间,但肝损害风险更高、程度更重,治疗期间需重点监测ALT、AST、GGT指标,及时保肝治疗以保障安全。
Abstract:
Objective:To investigate the clinical efficacy and characteristics of liver injury of dual induction therapy with all-trans retinoic acid (ATRA) combined with arsenic trioxide (ATO) versus single-agent ATRA or single-agent ATO in the treatment of newly diagnosed acute promyelocytic leukemia (APL),so as to provide evidence for optimizing clinical treatment.Methods:A total of 82 patients with newly diagnosed APL admitted to the People’s Hospital of Inner Mongolia Autonomous Region from January 2018 to January 2024 were enrolled.They were divided into three groups according to treatment regimen:dual induction group (44 cases,ATRA + ATO),ATRA monotherapy group (19 cases),and ATO monotherapy group (19 cases).Complete remission (CR) rate,time to complete remission (TCR),and abnormalities in liver function parameters were compared among the three groups.Results:Time to complete remission in the dual induction group (24.38 days) was significantly shorter than that in the ATRA monotherapy group (31.26 days) and the ATO monotherapy group (29.72 days) (all P<0.05).No significant difference was observed in CR rate among the three groups (97.72% vs 94.74% vs 94.74%,all P>0.05).The incidence of liver injury in the dual induction group (68.18%) was significantly higher than that in the ATRA monotherapy group (42.11%) and the ATO monotherapy group (47.37%).Among patients with liver injury,the proportion of grade Ⅲ–Ⅳ liver injury was markedly higher in the dual induction group (63.33%) than in the two monotherapy groups (25.00% and 33.33%,respectively),although the difference was not statistically significant (all P>0.05).The abnormal rates of alanine aminotransferase (ALT),aspartate aminotransferase (AST),and gamma-glutamyl transferase (GGT),as well as the peak levels of ALT and AST,were also significantly higher in the dual induction group (all P<0.05).No significant differences were found in time to peak levels of ALT,AST,and GGT among the three groups (allP>0.05),nor in the abnormal rates of alkaline phosphatase (ALP) and total bilirubin (allP>0.05).No significant difference was observed in liver toxicity profiles between the ATRA monotherapy group and the ATO monotherapy group (P>0.05).All patients with liver injury recovered to normal after standardized intervention (median recovery time:14 days),with no treatment-related deaths.Correlation analysis showed that higher severity of liver injury was associated with a trend toward shorter time to complete remission (r=-0.236,P=0.032).No recurrence was detected during a median follow-up of 18 months.Conclusion:The dual induction regimen of ATRA combined with ATO is effective in the treatment of newly diagnosed APL and can significantly shorten time to complete remission.However,it is associated with a higher risk and greater severity of liver injury.During treatment,close monitoring of ALT,AST,and GGT is recommended,and timely hepatoprotective therapy should be administered to ensure safety.

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备注/Memo

备注/Memo:
国家自然科学基金资助项目(8240010470);内蒙古自治区自然科学基金资助项目(2024LHMS08072);内蒙古医师协会临床医学研究和临床新技术推广基金项目(YSXH2025KYF59)
更新日期/Last Update: 2026-07-10