Objective To systematically review the effectiveness and safety of arsenic trioxide (ATO) versus retinoic acid for patients with acute promyelocytic leukemia (APL). Methods Such databases as PubMed, The Cochrane Library (Issue 12, 2012), CNKI, WanFang Data and VIP were electronically and comprehensively searched from inception to December 2012, for randomized controlled trials (RCTs) on the effectiveness and safety of ATO versus retinoic acid for patients with APL. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0.2 software. Results Eight RCTs involving 586 cases of APL patients. The results of meta-analysis showed that, ATO and all-trans-retinoic (ATRA) were not statistically different in CR rates (OR=0.85, 95%CI 0.54 to 1.35, P=0.50), CR time (OR=–8.14, 95%CI –16.42 to 0.13, P=0.05), recurrence rates (OR=0.14, 95%CI 0.02 to 1.21, P=0.07), early mortality (OR=0.82, 95%CI 0.32 to 2.06, P=0.67), and five-year total survival rates (OR=1.19, 95%CI 0.54 to 2.60, P=0.66). ATO had lower incidences of adverse reaction such as hyperleukocytosis syndrome (OR=0.32, 95%CI 0.18 to 0.58, P=0.000 1) and retinoic acid syndrome (OR=0.05, 95%CI 0.02 to 0.14, Plt;0.000 01). Conclusion ATO and ATRA are alike in CR rates, CR time, recurrence rates, early mortality, and five-year total survival rates, but ATO causes less adverse reaction. Due to the limited quantity and quality of the included studies, ATO should be applied with caution according to patients’ conditions in clinic.
目的:研究丹参酮ⅡA(Tan ⅡA)对急性早幼粒细胞白血病(APL)细胞株NB4细胞诱导的血管内皮细胞株(ECV304)促凝活性(PCA)的影响,并对其机制作初步探讨。方法:(1)分别用1.0μg/mL TanⅡA、0.3μg/mLATRA、0.01%DMSO、PRMI1640处理NB4细胞24、48和72h,取其上清液作为条件培养基(hNB4-CM)。将这些CM分别与ECV304细胞在37oC共同孵育0、4、8和12h,用反复冻融法制备ECV304细胞裂解液,采用一期凝血法测定其PCA;采用ELISA法测定条件培养基中的TNF-α 。(2)ECV304细胞与1.0μg/mL TanⅡA及TanⅡA 72h-NB4-CM 在37oC共同分别孵育6、12、24和48h,并以ATRA和DMSO分别作为阳性和阴性对照,用上述相同方法测定ECV304细胞裂解液的PCA。结果:(1)1.0 μg/mL Tan ⅡA可以诱导NB4细胞分化,其作用NB4细胞的培养基有一定的升高ECV304细胞PCA的作用,该作用在孵育4h时达高峰,之后ECV304细胞PCA逐渐下降。与0.3μg/mL ATRA的作用无统计学差异(Pgt;0.05)。(2)1.0 μg/mL的TanⅡA对TanⅡA72h-NB4-CM促ECV304细胞PCA有抑制作用,其强度随作用时间增加而增加,与1.0μmol/L ATRA比较,Pgt;0.05。(3)TanⅡA作用NB4细胞的培养基中TNF-α浓度,在作用前7h内随作用时间增加而增加,与0.3μg/mL ATRA比较无差异(Pgt;0.05)。结论:Tan ⅡA能诱导NB4细胞分化,后者在分化过程中释放的TNF-α可能与ECV304细胞PCA活性升高有关;Tan-ⅡA又能抑制Tan-ⅡA-NB4-CM增强ECV304细胞PCA的作用。