实体瘤化疗引起Ⅳ度骨髓抑制的临床分析
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摘要
目的:探讨实体瘤常规剂量化疗后出现Ⅳ度骨髓抑制的危险因素。方法:收集43例常规剂量化疗后出现Ⅳ度骨髓抑制的实体瘤患者及51例出现0-Ⅱ度骨髓抑制的实体瘤患者的临床资料,来探讨出现Ⅳ度骨髓抑制的危险因素及防治措施。结果:转移器官数目、化疗周期数、既往骨髓抑制程度是发生Ⅳ度骨髓抑制的独立危险因素(P=0. 002、0. 002、0. 001)。在分组分析中,这三个因素也是发生Ⅳ度白细胞减少的独立危险因素(P=0. 008、0. 030、0. 001)。结论:对于转移器官数目较多、曾行多周期化疗、既往曾发生严重骨髓抑制的患者在化疗期间予有效的预防措施及严密的随访,有利于防治Ⅳ度骨髓抑制。
Objective: To study the related risk factors of grade Ⅳ myelosupression of patients with solid tumor after conventional dosage chemotherapy. Methods: Collect the clinical data of 94 patients with solid tumor after conventional dosage chemotherapy,among whom,43 developed grade Ⅳ myelosupression,and 51 developed grade 0-Ⅱ myelosupression,to study the related risk factors of grade Ⅳ myelosupression and prophylactico-therapeutic measures.Results: The number of metastatic sites,the number of chemotherapy and the level of myelosupression occur in previous chemotherapy is independent risk factors of grade Ⅳ myelosupression( P = 0. 002,0. 002,0. 001 respectively).Subset analyses showed these three factors also is independent risk factors of grade Ⅳ leukocytopenia( P = 0. 008,0. 030,0. 001 respectively). Conclusion: Giving prophylactico-therapeutic measures and close follow-up to the patients who with more number of metastatic sites、more number of chemotherapy and severe level of myelosupression occur in previous chemotherapy can help prevent the happeness of grade Ⅳ myelosupression.
Objective: To study the related risk factors of grade Ⅳ myelosupression of patients with solid tumor after conventional dosage chemotherapy. Methods: Collect the clinical data of 94 patients with solid tumor after conventional dosage chemotherapy,among whom,43 developed grade Ⅳ myelosupression,and 51 developed grade 0-Ⅱ myelosupression,to study the related risk factors of grade Ⅳ myelosupression and prophylactico-therapeutic measures.Results: The number of metastatic sites,the number of chemotherapy and the level of myelosupression occur in previous chemotherapy is independent risk factors of grade Ⅳ myelosupression( P = 0. 002,0. 002,0. 001 respectively).Subset analyses showed these three factors also is independent risk factors of grade Ⅳ leukocytopenia( P = 0. 008,0. 030,0. 001 respectively). Conclusion: Giving prophylactico-therapeutic measures and close follow-up to the patients who with more number of metastatic sites、more number of chemotherapy and severe level of myelosupression occur in previous chemotherapy can help prevent the happeness of grade Ⅳ myelosupression.
引文
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[17]Zhu Yaokun,Zhou Yaocan,Dang Chengxue,et al.The fluctuation rule of leukocyte count and preventive strategy for patients with gradeⅣmyelosupression after conventional dosage of Docetaxel involved chemotherapy[J].Modern Oncology,2012,20(1):159-161.[朱摇琨,周摇灿,党诚学,等.多西他赛常规剂量化疗后Ⅳ度骨髓抑制患者白细胞计数波动规律及治疗策略[J].现代肿瘤医学,2012,20(1):159-161.]
[18]Liu Y,Lu Y,Zhang Y,et al.Risk management of side-effects of chemotherapy for breast cancer patients after hospital discharge[J].Clinical Research and Practice,2017,2(8):150-151.[刘颖,逯燕,张燕,等.乳腺癌患者出院后化疗不良反应的风险管理[J].临床医学研究与实践,2017,2(8):150-151.]
[19]Yao Y,Song Q,Chu Y,et al.Infusion of allogeneic umbilical cord blood hematopoietic stem cells in patients with chemotherapy-related myelosuppression[J].Exp Ther Med,2014,8(6):1946-1950.
[2]Wang L,Jie H,Zhang ZD.Related factors of severe bone marrow suppression of patients with breast cancer postoperation after chemotherapy[J].Tianjin Med,2013,41(7):707-709.[王林,解海,张振东.乳腺癌术后化疗诱发重度骨髓抑制的影响因素分析[J].天津医药,2013,41(7):707-709.]
[3]Xu XY,Zhu XQ,Liu XJ.Related factors of severe bone marrow suppression of patients with gyne-cologic malignant tumor after chemotherapy with TC program[J].Journal of Zhengzhou University(Medical Sciences),2016,51(5):657-660.[徐西岳,朱新群,刘小静.妇科恶性肿瘤患者TC方案化疗后发生重度骨髓抑制的影响因素[J].郑州大学学报(医学版),2016,51(5):657-660.]
[4]Li Yang,Zhang Ji,Shen Lida,et al.Bone marrow suppression of non-small cell lung cancer with bone metastasis after chemotherapy[J].Modern Oncology,2013,21(10):2238-2240.[李杨,张季,沈丽达,等.非小细胞肺癌骨转移化疗后的骨髓抑制分析[J].现代肿瘤医学,2013,21(10):2238-2240.]
[5]Wang SH,Wu YQ,Wang YF,et al.Related factors of bone marrow suppression of patients after chemotherapy[J].Jilin Med,2014,35(18):4010-4011.[汪曙红,吴怡青,王远飞,等.化疗后骨髓抑制的影响因素分析[J].吉林医学,2014,35(18):4010-4011.]
[6]Ma ZM,Huang GH,Liu GR,et al.Clinical effect of concurrent and sequential radiotherapy and chemotherapy in treatment of locally advanced non small cell lung cancer[J].Journal of Clinical Pulmonary Medicine,2017,22(5):911-914.[马兆明,黄关宏,刘桂荣,等.对比分析同期放化疗和序贯放化疗治疗局部晚期非小细胞肺癌的临床效果[J].临床肺科杂志,2017,22(5):911-914.]
[7]Liu S,Zheng YL,Zhou LY,et al.Advanced non-small cell lung cancer patients with chemotherapy-related bone marrow suppression and survival study[J].Journal of Clinical Pulmonary Medicine,2010,15(11):1544-1545.[刘淑,郑玉龙,周黎阳,等.晚期非小细胞肺癌患者化疗骨髓抑制与生存相关性研究[J].临床肺科杂志,2010,15(11):1544-1545.]
[8]Dong W,Li B,Wang Z,et al.Clinical signifcance of microRNA-24 expression in esophageal squamous cell carcinoma[J].Neoplasma,2015,62(2):250-258.
[9]Sun JM,Xiong HZ,Li XN.Hematopoietic stem/progenitor cells in tumorigenesis and tumor metastasis[J].Journal of International Oncology,2007,34(12):893-895.[孙晋敏,熊汉真,李学农.造血干细胞和祖细胞与肿瘤的发生和转移[J].国际肿瘤学杂志,2007,34(12):893-895.]
[10]Wang BH,Zhang MZ,Fu XR,et al.The research progress of mechanism and prevention of bone marrow suppression caused by chemoradiotherapy[J].Journal of Basic and Clinical Oncology,2013,26(2):162-165.[汪变红,张明智,付晓瑞,等.化放疗骨髓抑制机制及防治研究进展[J].肿瘤基础与临床,2013,26(2):162-165.]
[11]Liu SX,Wang Z,Yuan X,et al.Clinical observation and analysis of severe chemotherapy-induced myelosuppression effect[J].Chinese Journal of Geriatric Care,2015,13(2):95-97.[刘申香,汪竹,袁昕,等.肿瘤化疗致Ⅳ度骨髓抑制临床观察与分析[J].中国老年保健医学,2015,13(2):95-97.]
[12]You LS,Chen XY,Ye B.Efficacy of thymosin combined with chemotherapy in treatment of patients with non-small cell lung cancer and its influence on immune function[J].Joumal of Clinical Medicine in Practice,2017,21(5):42-45.[游莉斯,陈小艳,叶斌.胸腺肽联合化疗治疗非小细胞肺癌的疗效及对免疫功能的影响[J].实用临床医药杂志,2017,21(5):42-45.]
[13]Ju LW,Han T,Liu ZZ,et al.Shenqifuzheng injection combined with CEF in the treatment of breast cancer[J].China Clinical Practice Medicine,2017,8(1):23-26.[鞠伶伟,韩涛,刘兆喆,等.参芪扶正注射液联合CEF方案治疗乳腺肿瘤的临床分析[J].中国临床实用医学,2017,8(1):23-26.]
[14]Xie J,Liu Q,Wu LZ.Effect of Qijiaoshenbai capsule on bone marrow suppression and immune state of malignant gastrointestinal tumor after chemotherapy[J].The Practical Journal of Cancer,2015,30(10):1462-1465.[谢菁,刘泉,吴灵芝.芪胶升白胶囊对恶性消化道肿瘤化疗后骨髓抑制及免疫状态的影响[J].实用癌症杂志,2015,30(10):1462-1465.]
[15]Li J,Zhang S,Zhang J.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):925-929.[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):925-929.]
[16]Yu XT,Zhang Q,Lv JQ.Effects of different doses of recombinant human granulocyte colony-stimulating factor on prevention of secondary infections induced by bone marrow suppression after chemotherapy for advanced ovarian cancer[J].Chinese Journal of Nosocomiology,2014,24(17):4348-4350.[余小挺,张琼,吕杰强.不同剂量重组人粒细胞集落刺激因子对晚期卵巢癌化疗后骨髓抑制继发感染的预防[J].中华医院感染学杂志,2014,24(17):4348-4350.]
[17]Zhu Yaokun,Zhou Yaocan,Dang Chengxue,et al.The fluctuation rule of leukocyte count and preventive strategy for patients with gradeⅣmyelosupression after conventional dosage of Docetaxel involved chemotherapy[J].Modern Oncology,2012,20(1):159-161.[朱摇琨,周摇灿,党诚学,等.多西他赛常规剂量化疗后Ⅳ度骨髓抑制患者白细胞计数波动规律及治疗策略[J].现代肿瘤医学,2012,20(1):159-161.]
[18]Liu Y,Lu Y,Zhang Y,et al.Risk management of side-effects of chemotherapy for breast cancer patients after hospital discharge[J].Clinical Research and Practice,2017,2(8):150-151.[刘颖,逯燕,张燕,等.乳腺癌患者出院后化疗不良反应的风险管理[J].临床医学研究与实践,2017,2(8):150-151.]
[19]Yao Y,Song Q,Chu Y,et al.Infusion of allogeneic umbilical cord blood hematopoietic stem cells in patients with chemotherapy-related myelosuppression[J].Exp Ther Med,2014,8(6):1946-1950.