G-CSF 与GM-CSF 联合用药治疗化疗后骨髓抑制的比较

 目的 了解联合应用G-CSF和GM-CSF治疗Ⅱ度及以上化疗后骨髓抑制的可行性和安全性以及不良反应。方法84例确诊的恶性肿瘤化疗后出现Ⅱ度及以上骨髓抑制的患者，随机单盲分为GCSF组（G组：n=28，G-CSF150μg／d皮下注射），GM-CSF组（GM组：n=28，GM-CSF150μg／d皮下注射），联合用药组（G／GM组：n=28，G-CSF75μg／d和GM-CSF75μg／d皮下注射）。观察：（1）用CSF后WBC恢复正常所需天数；（2）停用CSF48h后WBC计数；（3）停用CSF48h后PLT计数；（4）不良反应发生率。结果 三组患者用药后均能有效提升白细胞。在WBC恢复正常天数上GM组明显长于G组和G／GM组（P〈0．05）；停药48h后WBC计数GM组和G／GM组明显高于G组（P〈0．05）；停用CSF48h后PLT计数GM组和G／GM组明显高于G组（P〈0．05）。三组不良反应发生率接近，组间比较无显著性差异。结论 GCSF和GM-CSF联合用药能安全、有效地治疗化疗后骨髓抑制，可避免单独用药的弊端，是化疗后骨髓抑制的有效治疗方法。

Comparison between Combination of G-CSF and GM-CSF in Patients With Arrest of Bone Marrow Caused by Chemotherapy

Objective 　To investigate the safety , feasibility and adverse reaction of combination of G-CSF and GM-CSF in patient s with Ⅱdegree and above arrest of bone marrow caused by chemotherapy. Methods 　84 patients with definite malignant tumor and Ⅱdegree and above arrest of bone marrow caused by chemotherapy were enrolled into a single-blinded and random study : G-CSF group ( G group , n = 28 , G-CSF 150μg/ d subcutaneous injection) , GM-CSF : group ( GM group : n = 28 , GM-CSF 150 μg/ d subcutaneous injection) ,combination drugs group ( G/ GM group , n = 28 ,GM-CSF 75 μg/ d and GM-CSF 75 μg/ d subcutaneous injection) . Observation items : (1) the days of WBC normalization af ter CSF application ;(2) WBC count after 48 hours withdrawal of CSF ; (3) PL T count af ter 48 hours withdrawal of CSF ; (4) incidence rate of adverse reaction. Results 　Leukcocyte count in three groups increased. The days of WBC normalization in GM group were longer than that in G group and G/ GM group ( P < 0. 05) . WBC count af ter 48 hours withdrawal of CSF in GM group and G/ GM group was obviously more than that in G group ( P < 0. 05) . Incidence rate of adverse reaction in three groups was approximate and there was no significant difference between groups. Conclusion 　Combination of G-CSF and GM-CSF was an effective and safe treatment to be applied in patient s with arrest of bone marrow caused by chemotherapy , and it could reduce the defect of single application.