目的: 观察培门冬酶治疗儿童急性淋巴细胞白血病（acute lymphoblastic leukemia,ALL）的近期疗效及对患儿不良反应的影响。方法: 选取我院2018年1月—2021年1月拟行化学治疗的ALL患儿86例为研究对象,以随机数法将所有患儿分为对照组与研究组,每组43例。对照组行长春新碱+柔红霉素+左旋门冬酰胺酶+泼尼松联合化疗（VDLP方案）;研究组行长春新碱+柔红霉素+国产培门冬酶+泼尼松联合化疗（VDPAP方案）。比较两组患者血红蛋白、幼稚细胞百分比、血小板计数及凝血功能及肝肾功能情况。比较两组患者临床缓解率、平均住院时间、用药次数和治疗6个月及1年的无事件生存率及不良反应。结果: 在治疗3个月后,研究组患者幼稚细胞百分比明显降低,对照组患者血红蛋白与PLT明显增加。与对照组比较,研究组患者谷丙转氨酶（ALT）与血尿素氮（BUN）、凝血酶原时间（PT）、活化部分凝血酶时间（APTT）、凝血酶时间（TT）值明显升高,白蛋白（ALB）与纤维蛋白原（FIB）明显降低。研究组患儿临床缓解率明显高于对照组。研究组患者住院时间与用药次数明显少于对照组,两组患者在治疗6个月及1年的无事件生存率比较差异无统计学意义。研究组患者胃肠道反应、过敏反应与低蛋白血症例数明显低于对照组。两组患者其他指标间差异无统计学意义。结论: 培门冬酶在儿童ALL治疗的有明显的优势,不仅能大幅度降低ALL患儿的骨髓抑制,促进淋巴细胞成熟,还能明显提升ALL患儿的凝血功能及临床缓解率,大幅降低不良反应。但相对来说,培门冬酶对肝功能有一定影响,需要进一步改进治疗方式以降低肝细胞受损率。

Objective To investigate the short-term efficacy of pegaspargase in the treatment of children with acute lymphoblastic leukemia and its effect on the adverse reactions of children. Methods In this study, 86 children with ALL who were scheduled to undergo chemotherapy in our hospital from January 2018 to January 2021 were prospectively selected as the research objects, and all the children were randomly divided into the control group and the study group, with 43 cases in each group, The control group received vincristine + daunorubicin + L-asparaginase + prednisone combined chemotherapy (VDLP scheme); The study group received vincristine + daunorubicin + domestic pegaspargase + prednisone combined chemotherapy (VDPAP scheme). Hemoglobin, percentage of immature cells, platelet count, coagulation function, liver and kidney function were compared between the two groups. The clinical remission rate, average length of hospital stay, number of medication and event-free survival rates at 6 months and 1 year of treatment were compared between the two groups. The adverse reactions of the two groups were compared. Results After 3 months of treatment, the percentage of immature cells in the study group was significantly decreased, and the hemoglobin and PLT in control group were significantly increased. Compared with control group, the values of ALT, BUN, PT, APTT and TT in study group were significantly increased, while ALB and FIB were significantly decreased. The clinical remission rate in study group was higher than in control group. The hospitalization time and medication times of study group were significantly less than those of control group, and there was no significant difference in the event-free survival rate between the two groups at 6 months and 1 year of treatment. The number of gastrointestinal reactions, allergic reactions and in study group was significantly higher than that in control group. There was no significant difference in other indicators between the two groups. Conclusion Peaspargase has obvious advantages in the treatment of children with ALL. It can not only greatly reduce the myelosuppression of children with ALL, promote lymphocyte maturation, but also significantly improve the coagulation function and clinical remission rate of children with ALL, and greatly reduce adverse reactions reaction, However, relatively speaking, pegaspargase has a certain effect on liver function, and it is necessary to further improve the treatment method to reduce the damage rate of liver cells.