沙利度胺联合化疗治疗急性白血病的疗效及其作用机制

目的：观察沙利度胺联合化疗治疗急性白血病的临床疗效及其对血浆血管内皮生长因子（VEGF）、碱性成纤维细胞生长因子（bFGF）、骨髓微血管密度（MVD）水平的影响。方法：急性白血病患者40例，随机分为试验组和常规组各20例。另选取同期接受健康体检的20例健康人作为对照组。试验组和常规组均予以常规化疗方案化疗，试验组同时口服沙利度胺每天100 mg；分别在治疗前及治疗后8周时采集外周血及骨髓病理，检测血浆中VEGF和bFGF含量、骨髓病理中MVD。结果：试验组与常规组的有效率分别为85%和70%，试验组高于常规组，但差异无统计学意义（P＞0.05）。治疗前试验组与常规组血浆中VEGF、bFGF水平均高于对照组（P＜0.05），试验组和常规组之间差异无统计学意义；治疗后试验组及常规组VEGF、bFGF水平仍均高于对照组（P＜0.05）；治疗后试验组VEGF水平低于常规组（P＜0.05），而bFGF水平治疗前后差异均无统计学意义（P＞0.05）。试验组和常规组患者治疗前MVD水平差异无统计学意义（P＞0.05），治疗后2组患者MVD均下降，但试验组MVD更低于常规组，2组差异有统计学意义（P＜0.05）。多元线性回归分析发现，急性白血病的疗效与化疗前的VEGF、MVD存在负相关。结论：沙利度胺联合化疗可提高急性白血病患者的缓解率，其部分作用机制可能是通过抑制血浆VEGF水平及减少MVD而发挥其抗血管增殖活性，从而产生抗白血病作用。

Efifcacy and mechanism of thalidomide combined with chemotherapy in the treatment of patients with acute leukemia

Objective：To observe the clinical effect of thalidomide combined with chemotherapy in the treatment of acute leukemia patients and its’ inlfuence on plasma concentration of vascular endothelial growth factor （VEGF）, basic ifbroblast growth factor （bFGF）, bone marrow microvessel density （MVD） level. MethodForty cases of acute leukemia patients, randomly divided into trial group and conventional group with 20 cases in each group. The other 20 healthy peoples were selected underwent physical examination as control group. The trial group and conventional group were treated with conventional chemotherapy, in the trial group additional tha-lidomide 100 mg/day were taken orally. Before treatment and 8 weeks after treatment, plasma were collected for the detection of VEGF, bFGF and bone marrow tissue for MVD. ResultThe effective rate of the trial group and the conventional group respectively were 85%and 70%, the effective rate of the trial group was higher than that of the conventional group, but the difference wasn’t statistically signiifcant （P＆gt;0.05）. Before treatment,the level of VEGF, bFGF in plasma of the trial group and the conventional group was signiifcantly higher than that in the healthy group （P＆lt;0.05）, and there’s no signiifcant difference between the trial group and the conventional group. After treatment, the levels of VEGF and bFGF of the trial group and the conventional group were still higher than those of the healthy group （P＆lt;0.05）, but there’s no signiifcant differences in bFGF levels before and after treat-ment （P＆gt;0.05）, the levels of VEGF in the trial group was lower than those in the conventional group after treat-ment （P＆lt;0.05）. Linear regression analysis indicated that the VEGF of plasma and the MVD level was negatively correlated with clinical effects （β=-0.065, t=-2.215, P＆lt;0.05;β=-0.078, t=-2.451, P＆lt;0.05）, and there’s no cor-relation between bFGF and clinical effects. Conclusion：Thalidomide combined with chemoth