FOLFOX化疗对男性患者性激素的影响及补肾益气中药的保护作用

Influence of Chemotherapy with FOLFOX Protocol on Sex Hormones of Male Patients and the Protective Effect of Herbal Medicines for Reinforcing Shen and Supplementing Qi on It

目的观察FOLFOX联合化疗方案对男性肿瘤术后患者的性激素影响及补肾益气中药的解毒保护作用。方法采用随机区组对照和自身对照实验设计,回顾性调查接受FOLFOX联合化疗的男性结直肠癌、胃癌术后患者的黄体生成素(LH)、雌二醇(E2)、泌乳素(PRL)、孕酮(P)、睾酮(T)和促卵泡激素(FSH)的变化。61例分为单纯中药组、FOLFOX组、FOLFOX加中药组和对照组(仅一般支持治疗)4组,治疗均1个月为1个疗程,共6个疗程。分别在治疗前、治疗结束时(治疗6个月时)和治疗12个月时监测各组的LH、E2、PRL、P、T和FSH。结果与治疗前及对照组、FOLFOX加中药组和单纯中药组的同期水平比较,FOLFOX组治疗后的LH、PRL和T均明显下降(均P<0.01),治疗结束时分别达(4.6±0.4)IU/L、(8.6±0.7)μg/L和(13.1±1.4)IU/L,之后有所回升,但治疗结束后6个月(即治疗开始12个月时)分别为(5.0±0.4)IU/L、(9.9±1.1)μg/L和(14.1±1.5)IU/L,仍低于治疗前水平以及对照组、FOLFOX加中药组和单纯中药组的同期水平(P<0.05或P<0.01);FOLFOX加中药组治疗后LH亦明显下降(P<0.05),低达(5.1±0.4)IU/L,但治疗结束后6个月时恢复至治疗前和对照组水平,达(6.1±0.5)IU/L;而该组PRL和T下降不明显(均P>0.05),治疗开始12个月时回升至治疗前和对照组水平。E2和FSH则相反,FOLFOX组E2和FSH治疗后血液浓度明显升高(均P<0.01),达(135±14)pmol/L和(9.1±1.1)IU/L,治疗开始12个月时分别为(140±15)pmol/L和(9.1±1.0)IU/L,未降至治疗前和对照组水平,亦明显高于FOLFOX加中药组和单纯中药组的同期水平(均P<0.01);而FOLFOX加中药组治疗后E2和FSH分别为(116±12)pmol/L和(7.1±0.9)IU/L,升高不明显(均P>0.05)。单纯中药组及对照组的上述指标无明显变化(均P>0.05);各组观察期内P无明显变化(均P>0.05)。结论FOLFOX联合化疗方案均可导致男性胃肠癌术后患者多种性激素水平失常,补肾益气类中药有不同程度的解毒保护作用。

Objective To observe the influence of chemotherapy with FOLFOX protocol （CT-F） on sex hormones of male patients, and the protective and detoxifying effect of herbal medicines for reinforcing Shen and supplementing qi （HM） on it. Methods The randomized block control and self-control design was adopted to retro-spectively investigate the changes of sex hormones in 61 patients with cancer of colon, rectum or stomach. They were assigned to four groups, A： treated simply with HM; B： treated with CT-F; C： treated with CT-F combined with HM; D： the blank control group. One course of CT-F composed of 1 month treatment, and 6 courses totally were applied on each patients. The levels of luteinizing hormone （ LH）, estradiol （ E2 ） , prolactin （ PRL）, progesterone （P）, testosterone （T） and follicle-stimulating hormone （FSH） were determined before treatment （T0）, at the end of the 6th month treatment （T1） and the 12th month （T2） after starting treatment. Results Levels of LH, PRL and T were significantly lowered in the group B at TI , being 4.6 ±0.4 IU/L, 8.6 ±0.7μg/L and 13.1 ± 1.4 IU/L, respectively, which were significantly different to those in the other 3 groups at the corresponding time ; they were somewhat raised after chemotherapy but still lower at T2 than those at TO, being 5.0 ±0.4 IU/L, 9.9 ± 1. 1 μg/L and 14. 1 ± 1.4 IU/L respectively, also lower than the corresponding levels in the other 3 Groups （P〈0.05 orP〈0.01）. In group C, LH significantly lowered at T1 （P〈0.05） to 5.1± 0.4 IU/L, but it was restored to the levels of TO and that in Group D, reaching 6. 1± 0. 5 IU/L ; while PRL and T were changed insignificantly in the chemotherapeutic course, and restored at T2 to the level of TO, comparable to that in group D. Contrarily, levels of E2 and FSH increased significantly （P 〈0. 01 ） in group B after chemotherapy （at T1 ） to 135 ± 14 pmol/L and 9. 1 ± 1. 1 IU/L respectively, and till T2, being 140 ± 15 pmol/L and 9.1 ±1.0 IU/L, they were lower than those at TO and higher than those in group D, A and C （all P 〈 0.01 ） , but the two indexes were not significantly increased in group C, being 116 ± 12 pmol/L and 7. 1 ±0.9 IU/L at TI. However, all the parameters showed no significant change in group A and D, and the level of P showed insignificant change in all the groups in the whole observation period. Conclusion CT-F could induce multiple sex hormonal abnormalities in male patients with post-operational gastrointestinal cancer, and HM shows protective and detoxifying effects on them in different degrees.