| 重组人粒细胞集落刺激因子预防乳腺癌化疗后骨髓抑制的疗效分析 |
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| 引用本文： | 李娇,张晟,张瑾. 重组人粒细胞集落刺激因子预防乳腺癌化疗后骨髓抑制的疗效分析[J]. 中国癌症杂志, 2014, 24(12): 925-930. DOI: 10.3969/j.issn.1007-3969.2014.12.008 |
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| 作者姓名： | 李娇 张晟 张瑾 |
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| 作者单位： | 天津医科大学肿瘤医院乳腺三科，国家肿瘤临床医学研究中心，中国天津乳腺癌防治研究中心，天津市肿瘤防治重点实验室，乳腺癌防治教育部重点实验室，天津300060 |
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| 基金项目： | 天津市重大科技专项(工程)项目抗癌重大科技专项(12ZCDZSY15700)。 |
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| 摘 要： | 背景与目的：骨髓抑制是化疗最严重的不良反应，以中性粒细胞减少最常见。重组人粒细胞集落刺激因子(recombinant human granulocyte colony-stimulating factor，rhG-CSF)能诱导造血祖细胞向中性粒细胞分化，并调节中性粒细胞的功能活性，可用于肿瘤化疗后严重的中性粒细胞缺乏症，以保证原计划化疗方案的完成。本文旨在了解应用rhG-CSF治疗乳腺癌化疗后骨髓抑制的疗效以及预防性作用。方法：采用回顾性调查方法，筛选出在天津医科大学肿瘤医院进行多西紫杉醇(docetaxel)75 mg/m2、表柔比星(epirubicin) 65 mg/m2与环磷酰胺(cyclophosphamide)500 mg/m2(TEC)化疗方案的浸润性乳腺癌患者，在第1个周期末次给药后24~48 h内给予rhG-CSF为预防组，以24~48 h内未给予rhG-CSF为对照组，评估2组化疗后骨髓抑制的发生情况以及用药的安全性。结果：在预防组60例患者中，外周血白细胞(white blood cell，WBC)＜4.0×109/L的发生率为25.0%，中性粒细胞绝对数(absolute neutrophil count，ANC)＜2.0×109/L的发生率为23.3%；在对照组60例患者中，WBC＜4.0×109/L的发生率为78.3%，ANC＜2.0×109/L的发生率为73.3%，差异有统计学意义(P＜0.01)。2组的化疗延迟率分别为5.0%和25.0%(P=0.002)，化疗延迟时间分别为(2.33±0.58)d和(3.73±0.80)d(P=0.011)，差异均有统计学意义。预防组发热性中性粒细胞减少症(febrile neutropenia，FN)的发生率为1.7%，对照组FN的发生率为20%，预防组明显低于对照组(P=0.001)。2组对血红蛋白(hemoglobin，Hb)与血小板(platelets，PLT)水平均无显著影响(P=0.547；P=0.285)。预防组rhG-CSF用药后不良反应的发生率为8.3%，而对照组为21.6%，差异有统计学意义(P=0.041)。结论：对于浸润性乳腺癌患者，在第一周期化疗后24~48 h内预防性给予rhG-CSF，能降低白细胞减少症的发生，减轻骨髓抑制的程度及持续时间，降低FN的发生风险，并且能减少rhG-CSF用药不良反应的发生。
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| 关 键 词： | 重组人粒细胞集落刺激因子 骨髓抑制 粒细胞减少症 预防性用药 |
Effect of recombinant human granulocyte colony-stimulating factor on bone marrow depression in breast cancer patients after the chemotherapy |
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| LI Jiao,ZHANG Sheng,ZHANG Jin. Effect of recombinant human granulocyte colony-stimulating factor on bone marrow depression in breast cancer patients after the chemotherapy[J]. China Oncology, 2014, 24(12): 925-930. DOI: 10.3969/j.issn.1007-3969.2014.12.008 |
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| Authors: | LI Jiao ZHANG Sheng ZHANG Jin |
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| Affiliation: | The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, China Tianjin Breast Cancer Prevention, Treatment and Research Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, China |
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| Abstract: | Background and purpose: Bone marrow depression is the severest chemotherapy toxicity and neutropenia is a common complication of myelosuppressive chemotherapy. Granulocyte colony-stimulating factor (G-CSF) stimulates the development of hematopoietic progenitor cells to neutrophils and modulates the actions of neutrophils and it can be used for severe neutrophil deficiency after chemotherapy in order to ensure the completion of the planned chemotherapy regimens. To evaluate the prophylactic effect of rhG-CSF used for chemotherapy-induced myelosuppression in Chinese breast cancer patients. Methods: Breast cancer patients who were taken docetaxel 75 mg/m2, epirubicin 65 mg/m2 and cyclophosphamide 500 mg/m2 (TEC) standard chemotherapy regimen were selectedin the retrospective study. Prophylactic group was preventively treated with rhG-CSF between 24-48 h after the first chemotherapy, and control group was not prophylactically treated with rhG-CSF. We would analysis the difference between 2 groups on myelosuppression induced by chemotherapy. Results: Among the 60 cases in prophylactic group, the rate of leukopenia was 25.0% and the rate of neutropenia was 23.3%. While, in the control group of 60 patients, the rates of leucopenia and neutropenia respectively were 78.3% and 73.3%. The difference between the 2 groups was statistically significant (P<0.01). Chemotherapy delayed rates in 2 groups were 5.0% and 25.0% respectively (P=0.002). Delayed time was 2.33±0.58 days and 3.73±0.80 days, respectively (P=0.011), showing significant differences between the 2 groups. The incidence of febrile neutropenia in prophylactic group was 1.7%, and the control group was 20%. The prophylactic group was significantly lower than the control group (P=0.001). rhG-CSF had no effect on the levels of hemoglobin and platelets (P=0.547; P=0.285). The adverse reactions incidence of prophylactic group was 8.3%, while the control group was 21.6%. The difference between the 2 groups was statistically significant (P=0.041). Conclusion: The application of rhG-CSF prophylactically in breast cancer patients after the chemotherapy can reduce the occurring rate of leucopenia, improve the decline of white blood cell and absolute neutrophil count, shorten the duration of chemotherapy-induced bone marrow depression, and reduce the risk of febrile neutropenia. Prophylactic drug use can reduce the adverse reactions of rhG-CSF. |
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| Keywords: | Recombinant human granulocyte colony-stimulating factor Myelosuppression Leucopenia Prophylactic drug use |
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