中国癌症杂志
中國癌癥雜誌
중국암증잡지
China Oncology
2015年
10期
823-827
,共5页
汪晓洁%寿涛%胡静%李世武%刘锐%缪堃
汪曉潔%壽濤%鬍靜%李世武%劉銳%繆堃
왕효길%수도%호정%리세무%류예%무곤
基因重组人粒细胞集落刺激因子%中性粒细胞减少%肿瘤%化学治疗
基因重組人粒細胞集落刺激因子%中性粒細胞減少%腫瘤%化學治療
기인중조인립세포집락자격인자%중성립세포감소%종류%화학치료
Recombinant human granulocyte-colony stimulating factor%Neutropenia%Tumor%Chemotherapy
背景与目的：肿瘤化疗最常见的剂量限制性毒性是骨髓抑制，其中白细胞和中性粒细胞减少最为常见。骨髓抑制不但使化疗药物的剂量提高受到限制，而且影响了化疗的正常进行。基因重组人粒细胞集落刺激因子(recombinant human granulocyte colony-stimulating factor，rhG-CSF)不仅具有刺激粒细胞集落形成的能力，也有促进粒细胞生长、增殖和分化的能力，对化疗所致白细胞和中性粒细胞减少具有明显疗效。本研究观察晚期非小细胞肺癌(non-small cell lung cancer，NSCLC)患者接受化疗后预防性应用低、中、高3种不同剂量的rhG-CSF升白效果及不良反应，探讨该药合理的应用策略。方法：126例经病理证实为晚期NSCLC化疗的患者，按数字随机法分为A、B、C共3组。3组患者于化疗结束后24 h给予rhG-CSF。其中A组(低剂量)：rhG-CSF 300μg，皮下注射，每日1次，共1天；B组(中剂量)：rhG-CSF 300μg，皮下注射，每日1次，共2天；C组(高剂量)：rhG-CSF 300μg，皮下注射，每日1次，共3天。观察患者用药后出现的症状和体征以及rhG-CSF的不良反应。结果：化疗后预防性使用中、高剂量rhG-CSF可以使近60%的患者白细胞高于4.0×109个/L；对于Ⅲ级白细胞减少的患者，低剂量组白细胞水平回升天数更长，高剂量组白细胞回升天数明显缩短，高剂量组和低剂量组之间差异有统计学意义(P<0.05)；从中性粒细胞的动态变化情况来看，化疗后加用高剂量rhG-CSF可以提高中性粒细胞的平均水平，能明显缩短化疗引起中性粒细胞低下的持续时间。126例患者中感染发生率为4.76%，其中低剂量组为9.52%，中剂量组为4.76%。rhG-CSF引起的不良反应轻微，患者能耐受。结论：化疗后预防性使用不同剂量rhG-CSF均可促进化疗患者白细胞和中性粒细胞的恢复，降低感染发生率。在相同化疗剂量下选用高剂量的rhG-CSF可使白细胞和中性粒细胞水平快速上升，安全可靠。
揹景與目的：腫瘤化療最常見的劑量限製性毒性是骨髓抑製，其中白細胞和中性粒細胞減少最為常見。骨髓抑製不但使化療藥物的劑量提高受到限製，而且影響瞭化療的正常進行。基因重組人粒細胞集落刺激因子(recombinant human granulocyte colony-stimulating factor，rhG-CSF)不僅具有刺激粒細胞集落形成的能力，也有促進粒細胞生長、增殖和分化的能力，對化療所緻白細胞和中性粒細胞減少具有明顯療效。本研究觀察晚期非小細胞肺癌(non-small cell lung cancer，NSCLC)患者接受化療後預防性應用低、中、高3種不同劑量的rhG-CSF升白效果及不良反應，探討該藥閤理的應用策略。方法：126例經病理證實為晚期NSCLC化療的患者，按數字隨機法分為A、B、C共3組。3組患者于化療結束後24 h給予rhG-CSF。其中A組(低劑量)：rhG-CSF 300μg，皮下註射，每日1次，共1天；B組(中劑量)：rhG-CSF 300μg，皮下註射，每日1次，共2天；C組(高劑量)：rhG-CSF 300μg，皮下註射，每日1次，共3天。觀察患者用藥後齣現的癥狀和體徵以及rhG-CSF的不良反應。結果：化療後預防性使用中、高劑量rhG-CSF可以使近60%的患者白細胞高于4.0×109箇/L；對于Ⅲ級白細胞減少的患者，低劑量組白細胞水平迴升天數更長，高劑量組白細胞迴升天數明顯縮短，高劑量組和低劑量組之間差異有統計學意義(P<0.05)；從中性粒細胞的動態變化情況來看，化療後加用高劑量rhG-CSF可以提高中性粒細胞的平均水平，能明顯縮短化療引起中性粒細胞低下的持續時間。126例患者中感染髮生率為4.76%，其中低劑量組為9.52%，中劑量組為4.76%。rhG-CSF引起的不良反應輕微，患者能耐受。結論：化療後預防性使用不同劑量rhG-CSF均可促進化療患者白細胞和中性粒細胞的恢複，降低感染髮生率。在相同化療劑量下選用高劑量的rhG-CSF可使白細胞和中性粒細胞水平快速上升，安全可靠。
배경여목적：종류화료최상견적제량한제성독성시골수억제，기중백세포화중성립세포감소최위상견。골수억제불단사화료약물적제량제고수도한제，이차영향료화료적정상진행。기인중조인립세포집락자격인자(recombinant human granulocyte colony-stimulating factor，rhG-CSF)불부구유자격립세포집락형성적능력，야유촉진립세포생장、증식화분화적능력，대화료소치백세포화중성립세포감소구유명현료효。본연구관찰만기비소세포폐암(non-small cell lung cancer，NSCLC)환자접수화료후예방성응용저、중、고3충불동제량적rhG-CSF승백효과급불량반응，탐토해약합리적응용책략。방법：126례경병리증실위만기NSCLC화료적환자，안수자수궤법분위A、B、C공3조。3조환자우화료결속후24 h급여rhG-CSF。기중A조(저제량)：rhG-CSF 300μg，피하주사，매일1차，공1천；B조(중제량)：rhG-CSF 300μg，피하주사，매일1차，공2천；C조(고제량)：rhG-CSF 300μg，피하주사，매일1차，공3천。관찰환자용약후출현적증상화체정이급rhG-CSF적불량반응。결과：화료후예방성사용중、고제량rhG-CSF가이사근60%적환자백세포고우4.0×109개/L；대우Ⅲ급백세포감소적환자，저제량조백세포수평회승천수경장，고제량조백세포회승천수명현축단，고제량조화저제량조지간차이유통계학의의(P<0.05)；종중성립세포적동태변화정황래간，화료후가용고제량rhG-CSF가이제고중성립세포적평균수평，능명현축단화료인기중성립세포저하적지속시간。126례환자중감염발생솔위4.76%，기중저제량조위9.52%，중제량조위4.76%。rhG-CSF인기적불량반응경미，환자능내수。결론：화료후예방성사용불동제량rhG-CSF균가촉진화료환자백세포화중성립세포적회복，강저감염발생솔。재상동화료제량하선용고제량적rhG-CSF가사백세포화중성립세포수평쾌속상승，안전가고。
Background and purpose:Myelosuppression is the most common dose-limiting toxicity of tumor chemotherapy in which leukocytopenia and neutropenia are the most common conditions. Not only are up-titrations of the doses of chemotherapeutic drugs limited, but also normal process of the chemotherapy is affected. Filgrastim-Recombinant Human Granulocyte Colony-Stimulating Factor (rhG-CSF) has the activity of stimulating the formation of granulocyte colony and promoting the growth, proliferation and differentiation of granulocytes which can be signiifcantly effective on leukocytopenia and neutropenia induced by chemotherapy. In this study, we observed the leukogenic effects, toxic and side effects of low, medium, and high doses of rhG-CSF used prophylactically after chemotherapy in patients with advanced non-small cell lung cancer (NSCLC), to explore a rational application strategy for rhG-CSF..Methods:One hundred and twenty six patients with pathologically proved advanced non-small cell lung cancer (NSCLC) under chemotherapy were digitally randomized to A, B and C groups. Filgrastim was given to patients of the three groups 24h after the end of chemotherapy. The dosages are: Group A (low dose): 300 μg of Filgrastim, s.c., qd × 1 day; Group B (medium dose): 300 μg of Filgrastim, s.c., qd × 2 days; Group C (high dose): 300 μg of Filgrastim, s.c., qd × 3 days. Then the signs and symptoms as well as toxic and side effects of Filgrastim after medication were observed.Results:Prophylactic usage of medium and high dosages of rhG-CSF could maintain WBC count at no less than 4.0×109/L in nearly 60% of patients. In patients with Grade III leukopenia, more days were needed for recovery of white blood cell (WBC) count with the low dose, while signiifcantly (P<0.05) less days were needed with the high dose. In view of the dynamic changes of neutrophil(ANC), additioning of the high dose of rhG-CSF after chemotherapy could increase the average level ofANC, notably shortening the duration of lowANC caused by chemotherapy. The incidence of infections was 4.76% for the 126 patients as a whole, 9.52% for the low dose group, and 4.76% for the middle dose group. The patients could tolerate the slight side effects incurred during treatment with Filgrastim.Conclusion:All of the three doses (low, medium, and high) of prophylactic administration of Filgrastim after chemotherapy can promote recoveries of WBCs and neutrophil granulocytes and reduce opportunities of infections. High doses of rhG-CSF can be faster and safer in increasing WBCs and neutrophil granulocytes.
