乳腺癌术后化疗不良反应的临床特点

Exploration on clinical characteristics of adverse reactions in postoperative chemotherapy of breast cancer

目的探讨分析乳腺癌术后化疗常见的不良反应特点。方法选取2011年1月至2014年1月经手术治疗后伴有浸润性乳腺癌的68例患者,按照随机数表法分为观察组和对照组。观察组为AC→T方案化疗,对照组为TAC方案化疗。比较两组患者化疗前1 d、化疗后7 d免疫功能、血象及细胞因子变化、化疗后的不良反应及其临床特点。结果化疗后观察组的CD4+、CD8+、CD4+/CD8+水平明显高于对照组,差异均有统计学意义[(43.22±2.76)%vs(37.32±1.78)%、(42.45±4.32)%vs(34.22±3.26)%、(1.96±0.35)vs(1.43±0.42),均P<0.000 1],免疫球蛋白Ig A、Ig G、Ig M水平明显低于对照组[(1.25±0.11)g/L vs(2.01±0.26)g/L、(8.21±1.22)g/L vs(11.34±2.33)g/L、(1.24±0.21)g/L vs(1.76±0.34)g/L,均P<0.000 1]。观察组患者的PLT、WBC、IL-4、IL-10水平明显高于对照组,分别为(175±24)×109/L vs(159±25)×109/L、(8.43±2.42)×109/L vs(7.11±1.78)×109/L、(46.32±4.22)U/ml vs(34.21±3.87)U/ml、(34.21±4.21)U/ml vs(25.45±3.87)U/ml(P=0.009、0.013、<0.000 1、<0.000 1)。观察组的中性粒细胞减少与减少性的中性粒细胞发热的不良反应发生率分别为44.12%、26.47%,明显比对照组低(79.41%、64.71%),差异有统计学意义(χ2=8.967、10.019,P=0.003、0.002)。结论乳腺癌术后采取不同化疗方案均存在不良反应,然而大多数为Ⅲ度以下的不良反应,并均能耐受,予以有效的处理后不良反应有所好转。

Objective To analyze the characteristics of adverse reactions in postoperative chemotherapy of breast cancer. Methods Sixty-eight patients of invasive breast cancer treated in Breast Disease Treatment Center of Chongqing Institute of Cancer from January 2011 to January 2014 were randomly divided into observation group and control group. The observation group were treated with AC→T regimen, and the control group with TAC regimen. Immune function, blood and cytokine level changes 1 day before and 7 days after chemotherapy were compared. After chemotherapy, adverse reactions and clinical characteristics of the two groups were observed. Results After chemotherapy, CD4＋, CD8＋, CD4＋/CD8＋ of the observation group were significantly higher than control group [（43.22 ± 2.76）% vs （37.32 ± 1.78）%, （42.45 ± 4.32）%vs （34.22 ± 3.26）%, （1.96 ± 0.35） vs （1.43 ± 0.42）, all P〈0.000 1]. Immunoglobulin IgA, IgG, IgM levels of observation group were significantly lower than control group respectively [（ 1.25 ± 0.11） g/L vs （2.01±0.26） g/L、（8.21±1.22） g/L vs （11.34±2.33） g/L, （1.24±0.21） g/L vs （1.76±0.34） g/L, all P〈0.000 1]. PLT, WBC, IL-4, IL-10 levels of observation group were significantly higher than control group [（175±24）×109/L vs （159±25）×109/L、（8.43±2.42）×109/L vs （7.11±1.78）×109/L、（46.32±4.22） U/ml vs （34.21± 3.87） U/ml、（34.21 ± 4.21） U/ml vs （25.45 ± 3.87） U/ml, P=0.009、0.013、〈0.000 1、〈0.000 1]. The adverse reaction rates of fever with neutropenia and reduction were 44.12% and 26.47%, lower than the control group （x2=8.967, 10.019, P=0.003, 0.002）. Conclusion The cancer patients taking chemotherapy have different adverse reactions, most of which are below degree Ⅲ, well tolerated, and can be improved after treatment.