伊立替康治疗结直肠癌相关胆碱能综合征89例

目的:观察和分析伊立替康治疗结直肠癌相关胆碱能综合征的发生情况.方法:应用2种FOLFIRI方案治疗转移性结直肠癌患者89例,观察和记录胆碱能综合征发生情况,并将其与患者临床资料、其他不良反应和所应用的治疗方案进行相关性分析.结果:53例(59.6%)患者发生胆碱能综合征,中位发生时间为伊立替康开始滴注后150min(30min-25h),绝大多数在用药后24h内逐渐消退,预防性应用阿托品可以有效预防胆碱能综合征发生;≥60岁老年患者胆碱能综合征明显高发(75.9%vs51.7%,P=0.029),未发现其与性别、ECOG评分等临床特征有关;出现胆碱能综合征患者迟发性腹泻有减少趋势(52.8%vs34.0%,P=0.077),未发现胆碱能综合征与其他不良反应相关;采用高剂量氟尿嘧啶治疗方案患者黏膜炎明显高发(50.0%vs27.5%,P=0.029).结论:伊立替康相关胆碱能综合征高发,应引起临床医生重视;胆碱能综合征对后续可能发生的迟发性腹泻和/或骨髓抑制无预测作用.

Irinotecan-related cholinergic symptoms in patients with colorectal cancer patients:an analysis of 89 cases

AIM:To observe and analyze irinotecan-related cholinergic symptoms in patients with advanced colorectal cancer.METHODS:A total of 89 patients with advanced colorectal cancer were assigned to receive two different FOLFIRI regimens.The incidence of cholinergic symptoms was recorded,and the correlation of the development of cholinergic symptoms with clinical characteristics,other adverse effects and chemotherapy regimens was analyzed.RESULTS:Fifty-three patients developed cholinergic symptoms.From the start of infusion,cholinergic symptoms occurred at a median of 150 min(range:30 min-25 h) and most of them regressed in 24 h.Prophylactic use of atropine could effectively prevent the development of cholinergic symptoms.Cholinergic symptoms were more common in senile patients(75.9% vs 51.7%,P = 0.029),but were not related with other clinical characteristics such as sex and ECOG score.Patients who developed cholinergic symptoms had a decreasing tendency to develop delayed-onset diarrhea.The regimen containing higher dose of fluorouracil was associated with a higher risk of developing mucocitis(50.0% vs 27.5%,P = 0.029).CONCLUSION:The incidence rate of irinotecanrelated cholinergic symptoms is unexpectedly high.The development of irinotecan-related cholinergic symptoms is not related with other adverse effects such as diarrhea and/or bone marrow depression.