摘要
目的探讨心理干预治疗难治性急性早幼粒细胞白血病(acute promyelocytic leukemia,APL)的临床疗效及作用机理。方法将71例难治性APL老年患者随机分为治疗组(36例)和对照组(35例),对照组采用复方青黛片常规治疗,治疗组在常规治疗基础上加用心理干预治疗。观察临床疗效及不良反应,并分别于治疗前后采用单克隆抗体-免疫磁珠分离系统(MACS)分离、纯化骨髓CD_(34)^+细胞;用SABC亲和细胞法和CMIAS系列多功能真彩图像分析仪检测骨髓CD_(34)^+细胞bcl-2表达。结果治疗组和对照组的完全缓解率、部分缓解率、总有效率分别为86.11%,8.33%,94.44%和74.29%,2.85%,77.14%.治疗组疗效明显优于对照组(P<0.01)。两组骨髓CD_(34)^+细胞bcl-2蛋白阳性产物的阳性率和OD值治疗前均较健康组明显增高(P<0.01),治疗后显著减低(P<0.01),治疗组减低幅度尤为明显,与对照组比较差异有显著性(P<0.01)。结论耐心细致的心理护理可明显提高中药砷剂的临床疗效和安全性;其作用机制可能是通过心理干预配合中药砷剂治疗能更有效下调凋亡抑制基因bcl-2表达,诱导或促进了APL骨髓CD_(34)^+细胞的分化和凋亡,使骨髓正常造血功能得以恢复重建。
Objective To study the clinical therapeutic effect and mechanism of mental intervention on acute promyeloeytic leukemia （ APL ）. Methods Seventy-one APL cases with randomly divided into two groups ： treatment group and control group. The patients in the control group were treated with conventional therapy, that is,chemical-compound indigo pulverata levis. And the patients in the group were treated not only with the same conventional therapy combined with additional mental intervention. And then the clinical therapeutic effect and the adverse reaction of the treatment were observed. Before and after treatment, we separated and purified CD34^ ＋ bone marrow cells with MACS,detected the expression of bcl-2 expression in CD34^＋ bone marrow cells with SABC technique and CMIAS multi function color photo instrument. Results In the treatment group, the complete remission rate was 86.11% ,the partial remission rate was 8.33% ,and the total effective rate was 94.44% ;in the control group, the complete remission rate was 74.9% , the partial rate was 2.85 % , and the total effective rate was 77.14%. There was significant difference between treatment group and control group, and the former one had a better effect than the latter one （ P 〈 0.01 ）. The positive rate and OD value of bcl-2 expression in CD34^ ＋ marrow cells of the two groups were increased significantly than the health （ P 〈 0.01 ） ,and decreased obviously after treatment （ P 〈 0.01 ）. The decreasing extent of the treatment group was more significantly than the control group. The difference （ P 〈 0.01 ） between them was statistically significant. Conclusion Careful mental treatment can improve the clinical therapeutic effect and security of Chinese herbal arsenic trioxide. Its mechanism maybe that the mental intervention and arsenic trioxide make the expression of bcl-2 protein down regulation, induce or promote the differentiation and apoptosis of CD34^ ＋ bone marrow cells,and make the hematopoiesis of the marrow recovery.
出处
《潍坊医学院学报》
2009年第4期244-246,共3页
Acta Academiae Medicinae Weifang
