老年非小细胞肺癌患者血清褪黑素的变化及其与化疗的关系

Changes of serum melatonin level in elderly patients with non-small-cell lung cancer and its relationship with chemotherapy

目的研究老年非小细胞肺癌(NSCLC)患者血清褪黑素变化及其与化疗的关系。方法将NSCLC患者149例按年龄分为老年组77例和非老年组72例,用高效液相荧光色谱法检测患者血清褪黑素水平,并对比分析化疗前后患者褪黑素、白细胞、血肌酐、尿素氮、T细胞亚群和自然杀伤(NK)细胞的变化。结果老年组与非老年组各项生化指标和T细胞亚群治疗前和治疗后比较差异均无统计学意义;血清褪黑素水平两组治疗前和治疗后各时间点比较差异亦均无统计学意义。老年和非老年组患者中午12:00和夜间00:00褪黑素含量变化均有昼夜节律性;夜间的褪黑素值在化疗前后老年组为32．3±6．5和21．7±9．8,非老年组为43．6±7．9和25．3±8．6,差异均有统计学意义(P<0．05);两组患者化疗前后白细胞、血肌酐的变化,差异均有统计学意义(P<0．05);尿素氮变化差异无统计学意义(P>0．05);患者T细胞亚群在治疗前后两组间的变化差异无统计学意义(P>0．05);NK细胞差异有统计学意义(P<0．01)。结论NSCLC患者随着化疗的进行,夜间褪黑素水平渐进性下降,化疗可能影响人体神经内分泌系统,进而影响了褪黑素的合成。测定夜间血清褪黑素水平对了解NSCLC临床治疗情况、减少不良反应有参考价值。

Objective To investigate the change of serum melatonin level in elderly patients with non-small-cell lung cancer（NSCLC）and its relationship with chemotherapy. Methods A total of 149 patients were divided into two groups according to age. The elderly group consisted of 77 patients （age≥60 yr）, the non-elderly group consisted of 72 patients （age〈60 yr）. Serum melatonin level was measured by high performance liquid chromatography （HPLC）. The changes of serum melatonin, leucocytes, serum creatinine, T cell subsets and NK cells after chemotherapy were evaluated. Results No significant difference was found in the changes of serum melatonin, leucocytes, serum creatinine, T cell subsets and NK cells between the elderly and nora elderly groups before chemotherapy, so was the ease after chemotherapy. There were circadian melatonin level changes in the two groups. Melatonin serum levels at night were significantly lower after chemotherapy （32. 3 ± 6.5 and 21.7 ± 9. 8 in the elderly group, 43.6 ± 7.9 and 25.3 ± 8. 6 in the non-elderly group）. In the course of chemotherapy, there were significant differences in the changes of leucocytes, serum creatinine levels and NK cells, but no difference was found in T cell subsets changes before and after chemotherapy. Conclusions The progressive decrease of melatonin concentrations along with chemotherapy in NSCLC patients may indicate a gradual function alteration of the neuroendocrine system. The melatonin serum level is important for evaluating the clinic chemotherapy therapeutics and reduce the drug toxicity.