不同化疗方案对晚期非小细胞肺癌患者肺功能的影响

The impact of pulmonary function in advanced non-small cell lung cancer patients treated by different chemotherapy regimens

目的探讨接受不同化疗方案的晚期非小细胞肺癌(NSCLC)患者化疗前后的肺功能变化情况。方法收集59例晚期NSCLC患者,分为吉西他滨联合铂类(GP)方案组和含紫杉类方案组,对化疗前、后的肺功能进行检测;另选取63例健康人作为对照组。结果肺癌组化疗前的肺通气功能指标RV和RV/TCL高于对照组(P>0.05),其余各项通气指标和弥散功能指标均明显低于对照组(P<0.05)。肺癌组化疗后除FEV1/FVC%较化疗前增高外(P<0.05),其余肺通气功能指标基本无明显改变,但弥散功能指标均明显下降。GP方案组化疗后肺通气功能指标FEV1/FVC%较化疗前增高(P<0.05),其余各项通气功能指标化疗前后的差异均无统计学意义(P>0.05),而化疗后肺弥散功能各指标均明显低于化疗前(P<0.05)。含紫杉类方案组化疗后肺小气道功能指标V25%较化疗前增高(P<0.05),其余各通气功能指标化疗前后的差异均无统计学意义(P>0.05),但化疗后各项肺弥散功能指标均显著低于化疗前(P<0.05)。结论晚期NSCLC患者存在肺功能的减退,应用吉西他滨或紫杉类药物化疗后肺弥散功能明显降低,提示两者均有一定的肺毒性,建议化疗前、后应常规检测肺功能。

Objective To evaluate the change of pulmonary function in advanced non-small cell lung cancer（NSCLC） pa- tients treated by different chemotherapy regimens before and after chemotherapy. Methods Fifty-nine patients with advanced NSCLC were divided into gemcitabine plus platinum（GP） group（n = 30） or taxol-based regimen（ n = 29）. Pulmonary function was tested on 59 cases of advanced NSCLC patients treated by different chemotherapy regimens before and after chemotherapy and 63 normal con- trols. Results Compared with control group, RV and RV/TCL were higher in NSCLC group before treatment （ P 〉 0. 05 ） , and the other indexes of ventilation function and diffusing capacity were significantly lower in NSCLC group （ P 〈 O. 05 ）. After chemotherapy, there was no significant change of ventilation function in NSCLC group except the raise of FEV1/FVC% （P 〈 0. 05 ） , and the patients with advanced NSCLC had a significant reduction in diffusing capacity post-chemotherapy. In GP group the ventilation function indexes had no differences before or after chemotherapy except the increase of FEV1/FVC% （P 〈 0. 05 ） after chemotherapy, and the diffusing capacity decreased after chemotherapy（ P 〈 0. 05 ）. In taxol-based group, V25% of small airway function increased after chemotherapy （ P 〈 0. 05 ） , while other indexes of ventilation function had no differences, and the diffusing capacity decreased after chemotherapy（ P 〈 0. 05 ）. Conclusion The pulmonary function decreases in advanced NSCLC patients with significant reduction in diffusing capacity postchemtherapy due to the pulmonary toxicity of gemcitabine and taxol. The pulmonary function should he detected pre-and post-chem- otherapy of NSCLC patients.