化疗对妇科恶性肿瘤患者绝经症状发生的影响

Effects of Chemotherapy on the Incidence of Menopausal Symptoms in Patients with Malignant Gynecological Tumor

目的探讨化疗对妇科恶性肿瘤患者绝经症状发生的影响。方法 2013年1—6月北京中医药大学利用中国中药协会循证药物经济学专业委员会中医药临床评价平台收集同济医院、协和医院、湖北省肿瘤医院、广东省人民医院收治的妇科恶性肿瘤患者217例,其中宫颈癌104例,卵巢癌69例,子宫内膜癌44例。按治疗方式分组为:未接受任何治疗组(75例)、非化疗组(15例)、单纯化疗组(78例)、化疗联合其他治疗组(49例)。比较4组患者绝经症状发生率及绝经症状积分,两因素析因方差分析化疗和雌激素受体(ER)对绝经症状积分的影响。结果 4组患者ER、孕激素受体(PR)、人类表皮生长因子受体2(HER2)阳性率比较,差异均有统计学意义(P<0.05)。未接受任何治疗组、非化疗组、单纯化疗组、化疗联合其他治疗组绝经症状发生率分别为:85.3%(64/75)、86.7%(13/15)、94.9%(74/78)、95.9%(47/49),差异有统计学意义(χ2=5.786 9,P=0.016 1);4组患者绝经症状积分分别为(1.41±0.21)分、(2.53±0.87)分、(3.14±0.35)分、(3.61±0.50)分,差异有统计学意义(F=15.18,P<0.000 1)。两因素析因方差分析结果显示,化疗和ER对绝经症状积分的影响差异有统计学意义(F=15.18,P<0.000 1)。化疗对绝经症状积分的影响差异有统计学意义(F=15.14,P<0.000 1),ER对绝经症状积分的影响差异无统计学意义(F=0.61,P=0.42)。两者的交互作用差异有统计学意义(F=5.06,P<0.002 1)。单独效应结果显示,在控制化疗这一因素后,在未接受化疗的两个组中,ER阳性阴性对绝经症状积分的影响差异无统计学意义(P>0.05);而在接受化疗的两个组中,ER阳性阴性对绝经症状积分的影响差异有统计学意义(P<0.05)。在控制ER阳性阴性这一因素后,无论ER阳性阴性,4组患者绝经症状积分差异均有统计学意义(P<0.05)。结论化疗会提高恶性肿瘤患者绝经症状的发生率及绝经症状积分,影响患者的生活质量。

Objective To investigate the effects of chemotherapy on the occurrence of menopausal symptoms in patients with malignant gynecological tumor.Methods From January to June in 2013,Beijing University of Chinese Medicine recruited 217 cases with gynecologic malignancies admitted by Tongji Hospital,Union Hospital,Hubei Cancer Hospital,Guangdong Provincial People＇s Hospital of Gynecological malignancies through the Clinical Chinese Medicine Evaluation Platform of Evidence- based Economics Professional Committee,Chinese Medicine Association,including 104 cases with cervical cancer,69 cases with ovarian cancer and 44 cases with endometrial cancer.They were divided into four groups according to the treatment ways：no treatment group（75 cases）,non- chemotherapy group（15 cases）,chemotherapy group（78 cases）,chemotherapy combined with other treatment group（49 cases）.Comparisons were made in the four groups about the incidence of menopausal symptoms and menopausal symptom score.Two- factor factorial variance analysis was used to examine the influence of chemotherapy and ER over menopausal symptoms.Results Positive rates of ER,PR,HER2 were statistically significant between the four groups（P〈0.05）.The incidences of menopausal symptoms in the four groups were：85.3%（64 /75）,86.7%（13 / 15）,94.9%（74 /78）,95.9%（47 /49） respectively,with significant difference（χ2= 5.786 9,P = 0.016 1）.The symptom scores were（1.41 ± 0.21） points,（2.53 ± 0.87） points,（3.14 ± 0.35） points,（3.61 ± 0.50） points respectively,with significant difference（F = 15.18,P 0.000 1）.Two- factor factorial variance analysis showed significant differences between chemotherapy＇s impact and ER＇s impact on the menopausal symptoms scores（F = 15.18,P 〈0.000 1）.The effects of chemotherapy were statistically significant in the four groups（F = 15.14,P 〈0.000 1）,the effects of ER were not statistically significant（F = 0.61,P = 0.42）.Interaction of the two was statistically significant（F = 5.06,P 〈0.002 1）.Single effect results showed no matter ER was positive or negative its effects were not significantly different in the two groups without receiving chemotherapy（P〉0.05）,while in another two groups receiving chemotherapy,the differences were statistically significant（P〈0.05）.After controlling ER＇s positive and negative,the differences of menopausal symptoms scores in the four groups were statistically significant（P〈0.05）.Conclusion Chemotherapy may result in the incidence of menopausal symptoms and symptom scores,and affect the quality of life of the patients.