【摘要】 目的了解长期口服四硫化四砷（As₄S₄）对急性早幼粒细胞白血病（APL）患者肝脏的慢性毒性。方法对长期服用 As₄S₄的 APL 患者各时期生化指标、超声检查结果（包括肝、脾大小形态,实质回声及门脉宽度的检查）及肝纤维化指标（PⅢNP 及Ⅳ型胶原）进行跟踪分析。结果 106例服用 As₄S₄的 APL 患者,中位随访时间为36（6～72）个月,丙肝阴性组84例,初始服用时,丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）高于2倍正常值的发生率分别为16.7%和15.5%.ALT、AST、γ-谷氨酰转移酶（GGT）水平比服药前有明显升高（P 值均<0.05）,连续用药0.5,1.0,2.0,3.0年及3.0年以上 ALT、AST、GGT 水平与用药前相比差异无统计学意义（P 值均>0.05）,其他生化指标:碱性磷酸酶（ALP）、乳酸脱氧酶（LDH）、总胆红素（TBIL）、直接胆红素（DBIL）、总蛋白（TP）、白蛋白（ALB）、白蛋白与球蛋白比值（A/G）、尿素氮（BUN）、肌酐（CRE）与用药前相比差异均无统计学意义（P 值均>0.05）;丙肝阳性组22例,初始服用时 ALT、AST 高于2倍正常值的发生率分别为63.6%和59.1%,连续用药2年后肝功能恢复至接近正常水平。连续用药3年以上的 APL 患者42例,丙肝阴性组33例患者中,2例睥肿大、1例门脉增宽,21例（63.6%）被诊断为脂肪肝,16例进行肝纤维化指标检测均为正常;丙肝阳性组9例患者中,4例脾肿大,2例门脉增宽,6例（66.7%）被诊断为脂肪肝,6例进行肝纤维化指标检测,2例高于正常值。结论 APL 患者长期服用 As₄S₄对肝功能无显著影响,未引起明显的肝纤维化和门脉高压症状,但脂肪肝发病率较高,应长期随访。更多还原

【Abstract】 Objective To investigate the chronic hepatic damage in acute promyelocytic leukemia （APL）patients long-term treated with tetra-arsonic tetra-sulfide（As₄S₄）Methods The periodical liver bi- ochemical examinations and ultrasonography results and hepatic fibrosis indicators（P Ⅲ NP and type Ⅳ colla- gen）of patients were analysed.Results 106 APL patients treated with As₄S₄,the median follow-up time was 36 months（6-72）.The HCV（-）group includes 84 APL patients.During the first conrse the abnomal rate of the alanine aminotransderase（ALT）and asparate aminotransferase（AST）wasl6.7% and 14.5%（higher than the two times of the nomal value）,the ALT、AST、γ-glyoxylate aminotransferase（GGT）levels during the first course were statistically higher than As4S4 treatment hetore（P<0.05）.There were no statistically differences between the ALT、AST、GGT levels after and before treating with As₄ S₄ in half a year、one year、two year、more than three years（P>0.05）.Other biochemical indicators such as ALP、LDH、TBIL、DBIL、TP、 ALB、A/G、BUN、CRE、there were no siganifieantly differences before and after As₄ S₄ treatment（P>0.05）. The HCV（+）group includes 22 APL patients,during the first course,the abnomal rate nf the ALT、AST were 63.6% and 59.1%,but at the 2 year、more than 3 years there were no siganificantly differences compared with As₄S₄ treatment before（P>0.05）.42 APL patients were treated with As₄S₄ more than 3 years,in 33 HCV（-）APL patients,two APL patients had splenomegaly,one APL patient,s breadth of the portal vein was wider than 1.4cm,21 APL patients had fatty liver（63.6%）.The hepatic fibrosis indicators of the 16 APL patients were all nomal.In 9 HCV（+）APL patients,4 APL patients had splenomegaly,2 APL patients, breadth of portal vein were wider than 1.4 cm,6 APL patients had fatty liver（66.7%）.6 patients were exam- ined with the hepatic fibrosis indicators,2 patients,were higher than the nomal value.Conclusion Long- term As₄S₄ treatment for APL patients had no obvious effects on hepatic function,no obvious hepatic fibrosis and portal hypertention signs at more than 3 years,excepting for the rate of fatty liver was high.更多还原