左旋门冬酰胺酶、培门冬酶对急性淋巴细胞白血病患儿的治疗效果比较OACSTPCD

Objective To compare the therapeutic effects of L-asparaginase and pegaspargase on children with acute lymphoblastic leukemia(ALL).Methods The clinical data of ALL children admitted to Wuxi Children's Hospital from June 2016 to September 2022 were retrospectively collected.According to different treatment methods,37 cases were randomly selected for theL-asparaginase group and the perasparagase group,respectively.Both groups received conventional basic treatment.On this basis,the L-asparaginase group was treated with L-asparaginase,and the perasparagase group was treated with perasparagase.Both groups were treated for 46 days and followed up for 3 months.The clinical efficacy and adverse reactions during the 46-day treatment period in both groups were analyzed.The lipid and glucose metabolism indicators before treatment,at 21 days,and after 46 days,as well as cytokines,coagulation function,and liver function before treatment,at 21 days,and after 46 days,were compared between the two groups.Results After 46 days of treatment,there was no statistically significant difference in the total remission rate between the perasparagase group and the L-asparaginase group(P＞0.05).However,the complete remission rate of the perasparagase group was higher than that of the L-asparaginase(x2=4.874,P＜0.05).Before treatment,after 21 and 46 days of treatment,and 3 months of follow-up,levels of serum insulin and C-peptide of the two groups showed a decreased trend,and the difference was statistically significant at different time points(P＜0.05).After 21 days of treatment,the perasparagase group was higher than the L-asparaginase group(t=3.372,3.704,P＜0.05).After 46 days of treatment and 3 months of follow-up,the serum triglyceride(TG)levels in two groups were higher than that before treatment and after 21 days of treatment,with the perasparagase group higher than that in the L-asparaginase group(t=7.181,5.635,P＜0.05).Before treatment,21 days and 46 days after treatment,the levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(L-6),interleukin-8(L-8),interleukin-10(L-10),interferon-γ(IFN-γ)and ferritin(SF)in two groups were firstly increased and then decreased.The differences at different time points were statistically significant(P＜0.05).After 21 days of treatment,the perasparagase group was higher than the L-asparaginase group(t=3.785-7.921,all P＜0.05),and after 46 days of treatment,the perasparagase group was lower than the L-asparaginase group(t=2.983-7.000,all P＜0.05).The duration of both prothrombin time(PT)and activated partial thrombin time(APTT)showed a trend of initially increasing and then decreasing.After 21 days of treatment,the PT and APTT durations in the perasparagase group were longer than those in the L-asparaginase group(t=2.985,P＜0.05).The levels of plasma fibrinogen(FIB)in both groups showed a trend of initially decreasing and then increasing.After 21 days of treatment,the FIB level in the perasparagase group was lower than that in the L-asparaginase group(t=5.711,P＜0.05).The levels of serum D-dimer(D-D),fibrinogen degradation products(FDP),alanine aminotransferase(ALT),and total bile acid(TBil)showed a trend of initially increasing and then decreasing in both groups.After 21 and 46 days of treatment,the levels in the perasparagase group were higher than those in the L-asparaginase group(t=3.566-40.745,all P＜0.05).During the treatment period,the incidence of total adverse reactions in the perasparagase group was higher than that in the L-asparaginase group(x2=7.341,P＜0.05).Conclusion Compared with L-asparaginase,using pegaspargase to treat children with ALL has a greater impact on the islet function,liver function and coagulation function,and the safety is relatively poor.However,it has better efficacy in reducing patient inflammatory response.Suitable drugs could be selected for clinical treatment according to the specific conditions of children.