目的 探讨西达本胺片联合注射用阿扎胞苷和维奈克拉片治疗高危初发老年急性髓系白血病患者的效果。方法 选取蚌埠医科大学第一附属医院2021年1月—2024年9月收治的40例高危初发老年急性髓系白血病患者临床资料，根据治疗方案不同将患者分为对照组（17例）和治疗组（23例）。对照组采用剂量爬坡给药口服维奈克拉片，第1天给予100 mg，第2天增至200 mg，第3～28天给予400 mg；同时第1～7天皮下注射注射用阿扎胞苷75 mg/m²。治疗组在对照组治疗的基础上口服西达本胺片，30 mg/次，2次/周，治疗28 d。比较两组临床疗效、微小病变残留（MRD）转阴、生化指标、生存情况。结果 治疗组完全缓解/完全缓解伴血液学不完全恢复（CR/CRi）率、MRD转阴率均高于对照组的CR/CRi率、MRD转阴率，但组间比较差异无统计学意义。治疗后，两组血清血管内皮生长因子（VEGF）水平显著降低，中性粒细胞绝对值（ANC）、血小板计数（PLT）水平升高（P＜0.05）；且治疗后，较对照组，治疗组血清VEGF水平更低，ANC、PLT水平更高（P＜0.05）。治疗组平均无进展生存期（PFS）、平均总生存期（OS）均长于对照组（P＜0.05）。结论 西达本胺片联合注射用阿扎胞苷和维奈克拉片治疗高危初发老年急性髓系白血病患者的疗效确切，能提高疾病缓解率，调节肿瘤标志物水平，缩短血细胞恢复时间，延长患者生存时间。

Objective To investigate the efficacy of Chidamide Tablets combined with Azacitidine for injection and Venetoclax Tablets in treatment of high-risk elderly patients with newly diagnosed acute myeloid leukemia. Methods The clinical data of 40 high-risk elderly patients with newly diagnosed acute myeloid leukemia admitted to First Affiliated Hospital of Bengbu Medical University from January 2021 to September 2024 were selected. The patients were divided into control group (17 cases) and a treatment group (23 cases) based on different treatment regimens. The control group received oral Venetoclax Tablets with a dose-escalation schedule: 100 mg on day 1, 200 mg on day 2, and 400 mg from day 3 to 28. Additionally, patients were sc administered with Azacitidine for injection 75 mg/m² from day 1 to 7. The treatment group received oral Chidamide Tablets (30 mg per dose, twice weekly) on top of the control group's regimen for 28 days. The clinical efficacy, minimal residual disease (MRD) clearance, biochemical indicators, and survival outcomes were compared between two groups. Results The complete response/complete response with incomplete count recovery (CR/CRi) rate and MRD negative conversion rate in the treatment group were higher than those in the control group, but there was no statistically significant difference between two groups. After treatment, the serum levels of vascular endothelial growth factor (VEGF) significantly decreased in two groups, while the absolute neutrophil count (ANC) and platelet count (PLT) levels were increased (P < 0.05). After treatment, the serum levels of VEGF in the treatment group were lower than those in the control group, while the ANC and PLT levels were higher than those in the control group (P < 0.05). The average progression free survival (PFS) and overall survival (OS) of the treatment group were longer than those of the control group (P < 0.05). Conclusion The combination of Chidamide Tablets, Azacitidine for injection and Venetoclax Tablets has a definite therapeutic effect on high-risk newly diagnosed elderly patients with acute myeloid leukemia. It can improve disease remission rate, regulate tumor marker levels, shorten blood cell recovery time, and prolong patient survival time.

R973