2025 年第 12 期 第 20 卷

VDPAP方案与VDLP方案治疗急性淋巴细胞白血病患儿临床效果和安全性的对比研究

A comparative study of clinical efficacy and safety between VDPAP and VDLP regimens in the treatment of children with acute lymphoblastic leukemia

作者：万科成刘英杰陈远禄林博艺冯小伟

英文作者：Wan Kecheng Liu Yingjie Chen Yuanlu Lin Boyi Feng Xiaowei

单位：海南省人民医院儿科，海口570311

英文单位：Department of Pediatrics Hainan General Hospital Haikou 570311 China

关键词：急性淋巴细胞白血病；培门冬酶；VDPAP方案；VDLP方案；临床疗效

英文关键词：Acutelymphoblasticleukemia;Pegaspargase;VDPAPregimen;VDLPregimen;Clinicalefficacy

• 摘要：

• 目的 比较VDPAP方案（长春新碱+柔红霉素+培门冬酶+泼尼松）和VDLP方案（长春新碱+柔红霉素+左旋门冬酰胺酶+泼尼松）治疗急性淋巴细胞白血病（ALL）患儿的临床效果和安全性。方法 选择2019年3月至2024年3月在海南省人民医院进行化疗的ALL患儿146例，按照随机数表法将患儿分为对照组和观察组，各73例。对照组采用VDLP方案治疗，观察组采用VDPAP方案治疗。比较2组患儿的治疗有效率、血常规［白细胞计数（WBC）、血小板计数（PLT）、红细胞计数（RBC）和血红蛋白］、凝血功能指标［活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、凝血酶原时间（PT）和纤维蛋白原（FIB）］、纤溶指标［纤溶酶原、组织型纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制剂-1（PAI-1）和纤维蛋白降解产物（FDP）］、血清炎症因子［白细胞介素6（IL-6）、IL-8、高敏C反应蛋白（hs-CRP）和γ干扰素］、血清肿瘤特异性生长因子（TSGF）、血管内皮生长因子（VEGF）和不良反应发生率。结果 2组患儿的治疗有效率差异无统计学意义（P>0.05）。治疗后，观察组患儿PLT、RBC、APTT、t-PA、PAI-1、γ干扰素水平明显高于对照组，而WBC、FIB、IL-6、IL-8、hs-CRP、TSGF和VEGF水平显著低于对照组（均P<0.05）。观察组患儿过敏发生率明显低于对照组［1.4%（1/73）比11.0%（8/73）］（P<0.05）。结论 VDLP方案和VDPAP方案治疗ALL患儿均有效。相较于VDLP方案，VDPAP方案能够改善血常规，抑制炎症反应，下调血清TSGF和VEGF水平，同时安全性高，但是VDPAP方案对ALL患儿的凝血功能、纤溶指标的影响更大，临床医师应根据患儿病情选择合适的方案。

• Objective To compare the clinical efficacy and safety of the VDPAP regimen (vincristine+daunorubicin+pegaspargase+prednisone) and the VDLP regimen (vincristine+daunorubicin+L-asparaginase+prednisone) in the treatment of children with acute lymphoblastic leukemia (ALL). Methods A total of 146 children with ALL who received chemotherapy at Hainan General Hospital from March 2019 to March 2024 were enrolled. They were divided into a control group and an observation group using a random number table, with 73 cases in each group. The control group was treated with the VDLP regimen, while the observation group was treated with the VDPAP regimen. The treatment response rate, blood routine parameters ［white blood cell count (WBC), platelet count (PLT), red blood cell count (RBC), and hemoglobin］, coagulation function indices ［activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin time (PT), and fibrinogen (FIB)］, fibrinolytic indices ［plasminogen, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), and fibrin degradation products (FDP)］, serum inflammatory factors ［interleukin-6 (IL-6), IL-8, high-sensitivity C-reactive protein (hs-CRP), and interferon-γ］, serum tumor-specific growth factor (TSGF), vascular endothelial growth factor (VEGF), and incidence of adverse reactions were compared between the two groups. Results There was no statistically significant difference in the treatment response rate between the two groups (P＞0.05). After treatment, the levels of PLT, RBC, APTT, t-PA, PAI-1, and interferon-γ in the observation group were significantly higher than those in the control group, while the levels of WBC, FIB, IL-6, IL-8, hs-CRP, TSGF, and VEGF were significantly lower than those in the control group (all P＜0.05). The incidence of allergies in the observation group was significantly lower than that in the control group ［1.4%(1/73) vs 11.0%(8/73)］(P＜0.05). Conclusion Both the VDLP and VDPAP regimens are effective in the treatment of children with ALL. Compared with the VDLP regimen, the VDPAP regimen can improve blood routine parameters, inhibit the inflammatory response, and downregulate the serum levels of TSGF and VEGF, with higher safety. However, the VDPAP regimen has a more significant impact on the coagulation function and fibrinolytic indices of children with ALL, so clinicians should select an appropriate regimen based on the children′s specific conditions.