培美曲塞联合顺铂化疗对非小细胞肺癌患者免疫功能及医院感染的影响

The effect of combined chemotherapy with pemetrexed and cisplatin on immune function and hospital infection in patients with non-small cell lung cancer

目的探讨培美曲塞联合顺铂化疗对非小细胞肺癌患者免疫功能的影响及其医院感染情况。方法本院2008年6月至2013年6月收治的110例非小细胞肺癌晚期患者,随机分为长春瑞滨联合顺铂治疗组(常规组)及培美曲塞联合顺铂治疗组(试验组),对两组患者治疗前后免疫功能及治疗后骨髓抑制、血液毒性及医院感染发生率情况进行分析。结果治疗后两组患者的网织红细胞百分数、中心粒细胞数、血小板计数均显著降低,但试验组患者高于常规组;试验组患者CD3、CD4、CD4/CD8以及NK细胞水平较治疗前升高,而CD8计数降低,但其所有指标均高于治疗后常规组;常规组患者治疗后CD3、CD4、CD8、CD4/CD8和NK细胞水平均显著降低;化疗结束后,试验组感染发生率低于常规组,且其感染的病原菌种类组成与常规组差异具有统计学意义,在所有的细菌感染中,试验组患者产ESBLs大肠埃希菌的感染率低于常规组,而铜绿假单胞菌的感染率高于常规组,差异有统计学意义(χ2=3.891、4.857,P=0.048、0.027)。结论培美曲塞联合顺铂化疗有助于减轻化疗导致的骨髓抑制与血液毒性反应,提高患者免疫力,降低住院期间院感发生率。

Objective To investigate the effect of the pemetrexed plus cisplatin chemotherapy on immune function and nosocomial infection for patients with non-small cell lung cancer. Methods Total of 110 cases of patients with advanced non-small cell lung cancer were collected into vinorelbine plus cisplatin group（conventional group） and pemetrexed plus cisplatin group（experimental group）, randomly. The immune function and bone marrow suppression, blood toxicity and incidence of hospital infection were analyzed before and after treatment in these patients, respectively. Results After treatment, the percentage of reticulocytes, the number of neutrophil and the platelet counts were significantly lower, but the patients in the experimental group had better data than the patients in conventional group. The levels of CD3, CD4, CD4/CD8 and NK cells of patients in experimental group were increased compared to the data before treatment, while the level of CD8 decreased, but all of its indexes were higher than conventional group after treatment. The levels of CD3, CD4, CD8, CD4/CD8 and NK cells were significantly lower in patients of conventional group after treatment. After completion of chemotherapy, there was a low incidence of infection in the experimental group compared to the conventional group and the pathogen species composition were significant different. In all bacterial infections, the ESBLs E. coli infection of experimental was lower than the conventional group, and Pseudomonas aeruginosa infection was higher than conventional group, with significant differences（χ^2 = 3.891, 4.857; P = 0.048, 0.027）. Conclusions Pemetrexed in combination with cisplatin chemotherapy helps to reduce bone marrow suppression and hematologic toxicity, could improve patient immunity and reduce the incidence of infection during hospitalization.