作　　者： (高锦洁）; (李其辉）; (王皓）; (王继军）; (克晓燕）; (胡凯）;

机构地区： 北京大学第三医院血液科,100191

出　　处： 《中华放射医学与防护杂志》 2017年第8期599-602,共4页

摘　　要： 目的 探讨造血干细胞移植中应用阿米福汀对全身放疗患者的口腔及胃肠道黏膜的保护作用、对骨髓造血重建的影响、药物不良反应及安全性。方法 回顾性分析本院2012-2016年接受全身放疗为预处理方案的造血干细胞移植病例共计32例，其中全身放疗前应用阿米福汀病例14例，放疗前未应用阿米福汀病例（对照组）18例，比较两组患者预处理放疗后发生口腔黏膜炎、胃肠道黏膜炎、应用肠外营养情况、骨髓造血重建以及阿米福汀相关不良反应等情况。结果 阿米福汀组病例发生3-4级口腔黏膜炎比例（14.3%）明显低于对照组（77.2%），差异有统计学意义（χ2=10.62，P〈0.05）。阿米福汀组患者发生2级及3级胃肠道黏膜炎比例分别为35.7%及61.5%，对照组发生2级及3级胃肠道黏膜炎比例分别为33.3%及66.7%，差异无统计学意义（P〉0.05）。阿米福汀组患者应用肠外营养比例为21.4%，对照组为38.8%，差异无统计学意义（P〉0.05）。阿米福汀组患者粒细胞植入中位时间为12 d，血小板植入中位时间为12.5 d，对照组患者粒细胞及血小板植入时间分别为11及13 d，两组比较差异无统计学意义（P〉0.05）。本研究未发现阿米福汀相关明显不良反应。结论 全身放疗前应用阿米福汀可明显减少严重口腔黏膜炎的发生，且耐受性良好，对造血干细胞植入无明显影响。 Objective To evaluate the efficiency of amifostine in protecting against oral and gastrointestinal mucositis in hematologic malignancies patients with high-dose total body irradiation following the hematopoietic stem cell transplantation, and assess the hematologic recovery as well as the potential side effect of amifostine. Methods Thirty-two hematologic malignancies patients underwent hematopoietic stem cell transplantation in our institution from 2012 to 2016 were retrospectively analyzed. All of them were treated with total body irradiation （700-1 200 cGy） and high-dose chemotherapy, in which 14 patients received 400 mg amifostine before radiotherapy. Prior institutional experience in 18 patients treated without amifostine was used as a historical comparison （no-amifostine group）. Results Severe oral mucositis occurred in 14.3% of patients in the amifostine group while 77.2% in the no-amifostine group（χ2=10.62, P〈0.05）. Total parenteral nutrition was used in 21.4% of amifostine group and 38.8% in no-amifostine group （P〉0.05）. The rates of grade 2 and 3 gastrointestinal mucositis were 35.7% and 61.5% in amifostine group, while in no-amifostine group the rates were 33.3% and 66.7%, respectively （P〉0.05）. No significant difference was found in engraftment times of granulocyte and platelet. No amifostine related side effects were observed. Conclusions The combination of amifostine and total body irradiation conditioning therapy during hematologic stem cell transplantation might reduce the severity of oral mucositis. The utilize of amifostine has no obvious effect on hematopoietic recovery and can be well tolerated.

关 键 词： 阿米福汀 全身放疗 细胞保护剂 造血干细胞移植