还原型谷胱甘肽预防奥沙利铂所致神经毒性的临床观察

Clinical observation of the prevention against neurotoxicity related to Oxaliplatin with use of reduced glutathione

目的探讨用还原型谷胱甘肽(GSH)预防及减轻奥沙利铂(OXL)引起急慢性神经毒性的临床应用价值。方法 106例结肠癌术后使用FOLFOX4方案辅助化疗的患者,随机分为两组,一组在使用OXL化疗前后给予GSH,另一组不给予GSH,观察两组患者急慢性神经毒性的发生率和发生程度,分析两组患者的中位无进展生存时间(PFS)是否有差异。结果急性神经毒性在试验组总的发生率为88.8%,对照组为90.3%(P值=0.801),两组间差异无统计学意义。慢性神经毒性治疗组总发生率为88.9%,显著低于对照组的100%(P<0.05),随着OXL累积剂量的增加,神经毒性的发生率也增加。治疗组与对照组中位随访46.0个月和46.5个月后,中位PFS分别为51.8个月与49.2个月(P值=0.848),差异无统计学意义。结论在OXL治疗前后使用GSH可以减轻慢性神经毒性的发生率和程度,而对急性神经毒性无影响。GSH不影响OXL的治疗疗效,对患者的中位PFS无影响。

Objective To explore the clinical application value of reduced Glutathione（GSH） to prevent and mitigate acute or chronic neurotoxicity with Oxaliplatin（OXL）.Methods 106 patients of colon cancer adjuvant therapy with FOLFOX4 were randomly divided into two groups.In the treatment group,the patients were treated with GSH before and after using OXL;in the control group,the patients were treated without the use of GSH.The incidence and occurrence of acute and chronic neurotoxicity between the two groups were observed and analyzed to determine whether there was a difference in median progression-free survival（PFS） between the two groups.Results The total incidence of acute neurotoxicity in treatment group was 88.8%,while 90.3% in the control group（P=0.801）.There was no significant difference between the two groups.The total incidence rate of chronic neurotoxicity in the treatment group was 88.9%,which was significantly lower than 100% in the control group（P0.05）.With the increase of the cumulative dose of OXL,the neurologic toxicity rate was increased.After 46 months median follow-up with the treatment group and 46.5 months with the control group,the medial PFS was 51.8 and 49.2 months respectively.There was no significant difference.Conclusion Use of GSH before and after OXL can reduce the incidence and degree of chronic neurotoxicity,but has no effect on acute neurotoxicity.GSH does not affect the curative effect of OXL and the median PFS.