术后辅助化疗对绝经前乳腺癌患者性激素和月经周期的影响

Influence of adjuvant chemotherapy on sex hormone levels and menstrual cycles in premenopausal patients with postoperative breast cancer

目的观察绝经前乳腺癌患者术后辅助化疗对其性激素和月经周期的影响,为临床选择综合治疗方案提供参考。方法应用回顾性分析及统计学方法,将97例绝经前乳腺癌患者按年龄不同分成3组,Ⅰ组:12例,年龄≤30岁;Ⅱ组:34例,年龄在31～40岁之间;Ⅲ组:51例,年龄≥41岁。分析不同组别在化疗过程中外周血血清雌激素(Eestrogen,E2)、孕激素(Progestin,P)、总睾酮(Testosterone,T)水平及其月经周期的变化。结果患者第一次接受化疗前,Ⅰ组患者血清E2、P、T浓度分别为:(283.73±53.12)pg/ml、(13.98±5.67)ng/ml、(48.64±16.73)ng/dl;Ⅱ组分别为:(278.86±59.36)pg/ml、(13.01±6.21)ng/ml、(46.32±17.09)ng/dl;Ⅲ组分别为:(243.11±90.12)pg/ml、(14.01±6.45)ng/ml、(43.89±18.88)ng/dl,各组E2、P或T间差异没有统计学意义(P值均>0.05)。随着患者接受化疗次数的增加,其血清中E2、P浓度在不同周期间差异存在统计学意义(P值均<0.01),即随着化疗周期的增加E2、P浓度逐渐降低;总睾酮(T)浓度在不同化疗周期间差异没有统计学意义(P值均>0.05),即T并没有随着化疗周期的增加而发生改变。化疗周期结束后,患者发生闭经率为41.2%,未闭经组E2、P、T浓度分别为:(53.66±37.91)pg/ml、(5.34±4.22)ng/ml、(43.32±22.04)ng/dl;闭经组分别为:(12.21±5.64)pg/ml、(0.5±0.2)ng/ml、(103.2±29.88)ng/dl,两组E2、P或T间存在差异,差异有统计学意义(P值均<0.01),即化疗诱导闭经后,患者血清E2、P浓度明显降低,血清T浓度显著升高。不同年龄组间闭经发生率及发生时间不同,患者年龄与化疗诱导的闭经发生率呈强正线性相关(r=1,P=0.016),年龄越大的患者接受化疗后,其发生的闭经可能性越大。患者年龄与闭经发生的时间呈强负直线相关(r=-0.99,P=0.031),患者年龄越大,其在化疗期间发生闭经的时间越早。结论绝经前乳腺癌患者术后接受辅助性化疗后,其血清E2、P浓度降低,T浓度反馈性增高,最终可引起患者闭经。

Objective To provide some messages for clinical comprehensive therapy, by investigating the changes of sex hormone levels and menstrual cycles in premenopausal patients with postoperative breast cancer treat- ed with adjuvant chemotherapy. Methods The changes of oestrogen （E2）, progestin （P）, testosterone （T） in the se- runa of peripheral blood and menstrual cycles were analyzed by retrospective analyses and statistical methods in the process of adjuvant chemotherapy, in 97 premenopausal patients with postoperative breast cancer. The patients were di- vided into three groups according to patient＇s ages： group I （12 eases, ≤30 years old）, group II （34 eases, 31,-40 years old）, and group m （51 eases, ≥41 years old）. Results Before the first chemotherapy, the levels of E2, P, T in serum of peripheral blood were （283.73＋53.12） pg/ml, （13.98±5.67） ng/ml, and （48.64±16.73） ng/dl in group I, （278.86±59.36） pg/ml, （13.01±6.02） ng/ml, and （46.32±17.09） ng/dl in group lI ,,（243.11±90.）/ml, （14.01±6.45） rig/ ml, （43.89±18.88） ng/dl in group III, respectively. There were no significant differences among the three groups （P〉 0.05）. However, the levels of E2, P were significantly different with chemotherapy cycles （P〈0.01）： the levels of E2, P gradually diminished with chemotherapy cycles. The T concentration did not changed with chemotherapy cycles （P〉 0.05）. Total amenorrhoea rate was 41.2% after chemotherapy cycles were over. The levels of E2, P, T were （53.66± 47.91） pg/ml, （5.34±4.22） ng/ml, （43.32±22.04） ng/dl in unamenorrhoea group, （12.21±5.64） pg/ml, （0.5±0.2） ng/ml, （103.2±29.88） ng/dl and in amenorrhoea group, respectively. There were significant differences between unamenor- rhoea group and amenorrhoea group （P〈0.01）. The levels of E2, P both significantly reduced, and the T levels were higher in amenorrhoea group. Amenorrhoea rates and time happened amenorrhoea were not the same in different age groups. There was a positive linear correlation between amenorrhoea rates and ages （r=l, P--0.016）, amenorrhoea rates were higher in older women than younger women. Time happened amenorrhoea showed negative linear correlation with ages （r=-0.99, P=0.031）, which were earlier in older women than younger women. Conclusion In premenopausal patients with postoperative breast cancer, the levels of E2, P in serum of peripheral blood gradually diminish, and the T levels feedback rise during chemotherapy. Amenorrhoea happens when the levels of E2, P diminished to some degree.