分次小剂量顺铂联合化疗对胃癌患者肾功能的影响

Effects of Fractionated Low Dose Cisplatin on Renal Functions of Patients with Gastric Carcinoma

背景与目的:大剂量顺铂化疗对肾功能的损害已有共识,但小剂量的顺铂化疗对肾功能的影响还有待进一步考证,本研究旨在观察分次小剂量顺铂为主的联合化疗方案对胃癌患者肾功能的影响。方法:31例胃癌患者均采用分次小剂量顺铂(20mg/m2,第1～3天)联合氟尿嘧啶、表阿霉素静脉化疗,于化疗前至化疗第14天,隔日查尿N-乙酰-β-D-葡萄糖苷酶(N-acetyl-β-D-glucosaminidase,NAG)、γ-谷氨酰转酞酶(gamma-glutamyltransferase,γ-GT)及尿常规,化疗第7天及第14天查血肌酐及血尿素氮。结果:31例患者中有13例在化疗前各项检查指标均正常,而化疗后各项指标正常者仅1例。18例化疗前有1项或多项指标异常,多为尿NAG、γ-GT增高,两者在化疗第4天明显增高,2周左右仍未降至正常水平;而血肌酐及尿素氮无明显变化。结论:分次小剂量顺铂联合化疗对患者肾功能仍有一定影响,且持续时间较长。

BACKGROUND ＆ OBJECTIVE： Cisplatin （DDP） in large dosage impairs renal functions, while the impact of fractionated low dose DDP on renal functions is unclear. This study was to evaluate the effects of fractionated low dose DDP on renal functions of gastric cancer patients. METHODS： From Sep. 1998 to Jun. 2002, 31 gastric cancer patients were treated with LFEP regimen at School of Oncology of Peking University： intravenous administration of calcium folinate （CF, 150 mg/m^2） at Day 1-3, 5-fluorouracil （5-FU, 500 mg/m^2） at Day 1-5, epirubicin （EPI, 60 mg/m^2） at Day 1, and DDP （20 mg/m^2） at Day 1-3. Urine N-acetyl-βD-glucosaminidase （NAG）, gamma-glutamyl transferase （γ-GT） and routine urine test were assessed before chemotherapy and every other day during the 14-day chemotherapy; serum creatinine （sCr） and urea nitrogen （BUN） were assessed at the 7th day and 14th day during treatment. RESULTS： Of the 31 patients, 13 had normal renal functions before chemotherapy, while only 1 had normal renal functions after chemotherapy. Urine NAG and γ-GT were changed significantly after chemotherapy： they were increased significantly on the 4th day and maintained higher than normal level for another 14 days thereafter. Meanwhile, no significant change in sCr and BUN were observed. CONCLUSION： Combined chemotherapy with fractionated low dose DDP still adversely affects renal functions of gastric cancer patients, however, the long-term effects need to be clarified.