肿瘤化疗药物诱导性周围神经病的临床横断面研究

Clinical and Electrophysiological Studies of Chemotherapy-induced Peripheral Neuropathy

目的:分析抗肿瘤药物导致的周围神经病(CIPN)临床特征及其发病时的药物累积剂量。方法:连续收集2009年3月至2010年2月于化疗后发生周围神经损害的84例肿瘤患者。对纳入的患者进行周围神经病量表(MNSI、MDNS、FACT/GOG-NTX)评估和肌电图检查。按责任药物将患者分为:奥沙利铂组、顺铂组、紫杉醇组、长春新碱组、沙利度胺组和联合用药组(紫杉醇+卡铂,紫杉醇+顺铂),分析不同责任药物所致CIPN的特征及其与累积剂量的相关性。结果:84例患者临床主要表现为肢体远端感觉障碍,少数患者伴疼痛和(或)肌力减退,肌电图结果异常者占82.14%。84例患者中使用奥沙利铂者60例,累积剂量(1089.26±310.31)mg/m^2;长春新碱8例,累积剂量(5.14±1.07)mg/m^3;紫杉醇4例,累积剂量(640.00±306.17)mg/m^2;顺铂3例,累积剂量(360.00±120.00)mg/m^2。奥沙利铂组周围神经病量表分值与药物累积剂量呈正相关。结论:CIPN具有剂量依赖性特点,常见的责任药物为奥沙利铂、长春新碱、紫杉醇、顺铂。

Aim： To analyze the clinical manifestations and the electrophysiological features ofchemotherapy- induced peripheral neuropathy （CIPN）. Method： 84 patients who met the inclusion criteria for CIPN were included from March 2009 to February 2010. The Michigan Neuropathy Screening Instrument （MNSI）, Michigan Diabetic Neuropathy Score （MDNS） and FACT/GOG-NTX were applied to all the patients. Nerve conduction study （NCS） was also performed on most of the patients. The relative ratio between the mean cumulative dosage of oxaliplatin and the severity of CIPN was also studied. Results： Totally 84 patients of CIPN were in rolled. The most common complaints of these patients were burning pain and numbness of the extremities, especially in the lower ones. When examined, the tendon reflex, the pin prick sensation and/or vibration sensation of the affected extremities were decreased or absent. NCS was studied in 69 patients （82.14%）. As to the correspond drug, oxaliplatin was prescribed to 60 patients, the mean cumulative dosage being （1 089.26 ± 310.31）mg/m^2 when the patients got CIPN. As with other drugs, the mean cumulative dosage of vincristine in 8 patients was （5.14 ± 1.07）mg/m^2, paclitaxel in 4 patients being （640.00 ± 306.17）mg/m^2,cisplatin in 3 patients being （360.00 ± 120.00）mg/m^2. A positive linear correlation between the MNSI, MDNS scores and the cumulative dosage of oxaliplatin was found. Conclusion： CIPN could be induced by any of the following anti-neoplasm agents such as oxaliplatin, vincristine, paclitaxel and cisplatin. The severity of oxaliplatin- induced peripheral neuropathy was correlated to its cumulative dosage.