健择与顺铂联合去甲斑蝥酸钠治疗晚期NSCLC疗效观察

目的：观察健择和顺铂联合去甲斑蝥酸钠治疗晚期（ⅢB和IV期）非小细胞肺癌（non-smallcelllungcancer，NSCLC）的临床疗效和不良反应。方法：选择2010—01—01—2012—02—28在莱芜市中医院住院治疗的晚期（ⅢB和Ⅳ期）NSCLC患者180例，患者均经胸部CT和病理学确诊，KPS评分均≥70。180例患者随机抽样分为治疗组和观察组，每组90例，进行病例对照研究。治疗组顺铂30mg／m2＋NS250mL，静脉滴入，dl～d3；健择1000mg／m2＋NS250mL，静脉滴入，30min，d1，d8，dl5；去甲斑蝥酸钠注射液250mL，静脉滴入，d1～d2；28d为1个周期。对照组顺铂30mg／m2＋NS250mL，静脉滴入，d1～d3；健择1000mg／m2＋NS250mL，静脉滴入，30min，d1，d8，d15；28d为1个周期。两组患者于治疗3个周期后进行疗效评价。结果：治疗组有效率为80．OO％，对照组有效率为55．56％，两组差异有统计学意义，x2=11．253，P=0．0067。化疗后治疗组白细胞下降发生率为46．67％，对照组为85．56％，两组差异有统计学意义，x2=33．1593，P=0．007；治疗组血小板下降发生率为50．00％，对照组为84．44％，两组差异有统计学意义，x2=28．644，P=0．008；治疗组转氨酶升高发生率为24．44％，对照组为51．1l％，两组差异有统计学意义，P=0．0472；治疗组血清尿素氮升高发生率为11．11％，对照组为15．56％，两组差异无统计学意义，P=0．7981。治疗组恶心和呕吐不良反应率为18．9％，对照组为20％，两组差异无统计学意义，P〉0．05；治疗组皮肤改变发生率为3．3％，对照组为4．4％，两组差异无统计学意义，P〉0．05。结论：治疗组较对照组有效率明显提高；部分化疗毒副作用明显减轻，提高了患者对化疗的耐受性。健择与顺铂联合去甲斑蝥酸钠治疗晚期NSCLC的方案值得在临床推广应用。

Gemcitabine and ciplatin combined with norcantharidin sodium for the treatment of advanced NSCLC

OBJECTIVE： To observe the clinical effect of gemcitabine combined with cisplatin and sodium norcan tharidin in the treatment of advanced （ Band IV ） in non-small cell lung cancer（non-small cell lung cancer, NSCLC）. METHODS： One hundred and eighty cases of advanced NSCLC patients were selected and the diagnosis were conformed by chest CT and pathology. Karnofsky score was 〉70 points. The 180 patients were divided into treatment group and observation group,90 cases in each and a case-control study was performed. The regimen for chemotherapy in treatment group was 28 days for a period, respectively, at 1,2,3-day intravenous infusion of cisplatin 30 mg/m2 NS 250 mL ; 1,8, 15-day intravenous infusion of gemcitabine 1 000 mg/m2-k NS 250 mL （30 rain） ;1-21day intravenous infusion of norepi- nephrine cantharidin sodium injection 250 mL. The chemotherapy regimen for control group was 28 days for a period, re- spectively,at 1,2,3-day intravenous infusion of cisplatin 30 mg/m2 NS 250 mL; 1,8,15-day intravenous infusion of gemcitabine 1 000 mg/m2- NS 250 mL （30 rain）. The efficacy was evaluated between two groups after three cycles of treatment. RESULTS： The effective rate in treatment group was 80.00 % in the control group was 55.56 %, the differencewas statistically significant （P=0. 006 7）. The incidence of leucocytopenia after chemotherapy in treatment group was 46.67 % and the control group was 85.56%, the difference was statistically significant （P = 0. 007）. Thrombocytopenia occurred rate in treatment group was 50.00 % and 84.45 % in the control group, the difference was statistically significant （P=0. 008）. Changes of transaminase in the treatment group was 24.44% and in the control group was 51. 11%, the difference was statistically significant （P = 0. 047 2）. BUN changes in the treatment group was 11. 11 % and in control group was 15.56 %, the difference was not statistically significant （P = 0.798 1）. Nausea, vomiting adverse reaction rate in the treatment group was 18. 9% and in control group was 20. 00%, the difference was not statistically significant （P〈0.05） ;Cutaneous adverse reaction rate in the treatment group was 3.3 % and in the control group was 4.4%, the differ ence was not statistically significant, P〈0.05. CONCLUSIONS： In short, the efficiency of the treatment group is obviously improved than that of the control group and some side effects are reduced obviously which can improve the patient＇s toler- ability chemotherapy. Gemcitabine and cisplatin combined with norcantharidin sodium for advanced NSCLC plan is worth to popularize in the clinical application.