重组人粒细胞集落刺激因子治疗老年软组织肉瘤患者化疗后骨髓抑制的临床观察

Clinical efficacy of recombinant human granulocyte colony-stimulating factor on treatment of chemotherapy-induced myelosuppression in the elderly with soft tissue sarcoma

目的观察比较两种方法应用重组人粒细胞集落刺激因子（rhG-CSF）治疗老年软组织肉瘤患者化疗引起白细胞下降的效果，为临床用药提供指导。方法选择解放军总医院骨科2010年1月至2014年1月经由我院病理科确诊的原发性软组织肉瘤老年患者82例，全部采用MAID（美司钠、多柔比星、异环磷酰胺及达卡巴嗪）化疗方案，随机分为两组，A组患者在全部化疗给药结束后24h内应用rhG-CSF注射液2．5μg/kg，1次／d，连续应用14d至白细胞≥4．0×10^9／L停药。B组患者于全部化疗给药结束后监测血常规，当达到Ⅱ级骨髓抑制时应用rhG-CSF注射液5μg／kg，1次／d，连续应用7d或白细胞≥4．0×10^9／L停药。观察患者化疗后白细胞最低值、恢复到的最高值及恢复时间、用药时间及次数。结果（1）两组患者在一般情况方面差异无统计学意义（P〉0．05）。（2）两组患者的白细胞最低值差异无统计学意义（P〉0．05），B组患者的白细胞最高值及恢复时间略低于A组（P〈0．05）。（3）B组患者在用药时间及用药次数方面明显低于A组患者（P〈0．05）。结论B组患者采用的高剂量短时间给药方法可确切提高外周血白细胞数目，同时减轻患者所受痛苦，值得临床应用。

Objective To evaluate the efficacies of 2 different administration methods with recombinant human granulocyte colony- stimulating factor （rhG-CSF） on treatment of leukopenia in the elderly patients with soft tissue sarcoma after chemotherapy. Methods Eighty-two elderly patients with pathologically verified soft tissue sarcoma admitted in our hospital during January 2010 and January 2014 were enrolled in our study. After chemotherapy regimen of MAID （mesna, doxorubicin, ifosfamide, and dacarbazine） , they were randomized into Group A and Group B. The patients of Group A received 2.5 μg/kg rhG-CSF within 24 h after chemotherapy, once per day, for 14 d or till the white blood cell （WBC） count over 4.0 × 10^9/L. While those from Group B were monitored for their blood routine after chemotherapy, and received 5 μg/kg rhG-CSF per day only when they were at grade 11 bone marrow suppression, once per day for 7 d or till the WBC count over 4.0 × 10^9/L. Minimal WBC count, recovery maximal WBC count, recovery time, treatment duration and treatment times were observed to evaluate the two administration methods. Results （1）There were no significant differences in general information between the two groups （ P 〉 0.05 ）. （ 2 ） No statistical significance was seen in the mini- mal WBC count between the 2 groups （ P 〉 0.05 ）. But Group B had shorter recovery time and higher recovery maximal WBC count than Group A （P 〈 0. 05 ）. （ 3 ） The treatment durations were obviously shorter and the treatment times were significantly lower in Group B than in Group A （ P 〈 0.05 ）. Conclusion The method of applying rhG-CSF in group B with high dose and short treatment duration indeed improves WBC counts in the patients with chemotherapy-induced myelosuppression, and it also alleviates the pain after rhG-CSF injection. Thus, it is worthy of clinical application.