低分子肝素治疗对ⅢB期非小细胞肺癌化疗效果的影响

Effects of enoxaparin in chemotherapy patients with stage phase Ⅲ B non-small cell lung cancer

目的评价低分子肝素治疗对ⅢB期非小细胞肺癌化疗结局的影响。方法62例不可手术切除的ⅢB期非小细胞肺癌患者接受了多西紫杉醇联合顺铂（DP）方案化疗（多西紫杉醇75mg／m^2，静滴60min；顺铂75mg／m^2，静滴2h，每21天为1个周期，共4～6个周期），患者随机进入低分子肝素治疗组（化疗之日起每日1次低分子肝素钠注射液（齐征）100IU／kg，皮下注射，连用5d）或非肝素治疗组，比较两组患者的生存时间、无进展生存时间、粒细胞减少、功能状态评分、出血事件及D-二聚体水平。结果低分子肝素治疗组的1年整体生存率（64．52％）、2年整体生存率（22．58％）均大于非肝素治疗组（38．71％，9．68％），差异有统计学意义（P=0．048）；低分子肝素治疗组的1年无进展生存率（32．26％）、2年无进展生存率（12．90％）和非肝素治疗组（29．03％，9．68％）相比差异无统计学意义（P=0．723）；粒细胞减少、ZPS评分以及出血事件在两组之间无显著性差异；治疗结束时低分子肝素治疗组D-二聚体水平[（145．97±58．66）μg／L]低于非肝素治疗组[（190．39±55．81）μg／L]，差异有统计学意义（P=0．003）。结论低分子肝素治疗可以延长多西紫杉醇联合顺铂化疗方案治疗ⅢB期非小细胞肺癌患者的生存时间，改善血液高凝状态。

Objective To evaluate the effect of low molecular heparin in chemotherapy of phase Ⅲ B non-small cell lung cancer. Methods 62 patients with ⅢB non-small cell lung cancer were administrated the chemotherapy of docetaxel combined with cisplain （docetaxel 75 mg/m^2 , combined with cisplain 75 mg/m^2 given in one hour and two hours respectively, with the total of 4-6 circles）. Patients were randomly assigned to receive low molecular heparin therapy（low molecular weight heparin sodium gel 100 IU/kg given subcutaneously for five days on every circle） or not. The overall survival, progression-free survival, frequency of granuloeytopenia, functional status score, hemorrhage event, and level of D-dimer between the two groups were compared. Results The one-year or two-year overall survival rate in treatment group with low molecular heparin was higher than that in treatment group without low molecular heparin treament （64.52% vs 38.71%,22.58% vs 9.68%, P =0. 048）. The oneyear or two-year progression-free survival was similar in treatment group with low molecular heparin and treatment group without low molecular heparin （32.26% vs 29.03%, 12.90% vs 9.68%, P = 0. 723）. The performance status score, granulocytopenia, and hemorrhage event were similar between the two groups. The level of D-dimer in treatment group with low molecular heparin was lower than that in treatment group without low molecular heparin [（145.97±58.66） μg/L vs （190.39±55.81） μg/L, P = 0. 003]. Conclusions Low molecular heparin therapy may help extend the overall survival of phase ⅢB non-small cell lung cancer with the therapy of docataxel and cisplain and alleviate hypercoagulable states of blood.