行 AC-T 序贯治疗乳腺癌化疗方案患者多西他赛血药浓度监测的临床价值

Clinical value of monitoring of plasma docetaxel concentration in patients with breast cancer in AC -T sequential chemotherapy

目的：研究乳腺癌患者化疗后，多西他赛（DTX）血药浓度与疗效及毒副作用的相关性。方法选择湖北省肿瘤医院2015年4-9月接受 AC-T 序贯治疗方案一线化疗的71例乳腺癌患者为研究对象。用胶乳免疫比浊法于每周期 DTX 静脉输注后检测其血药浓度。根据血药浓度分布分为≤2．0 mg·h^-1·L^-1组（A 组）、〉2．0-2．5 mg·h^-1·L^-1组（B 组）和〉2．5 mg·h^-1·L^-1组（C 组），采用χ^2检验回顾性分析血药浓度与不良反应程度、疗效之间的相关性。结果A 组、B 组、C 组 DTX 血药浓度分别为（1．55±0.36）mg·h^-1·L^-1、（2．28±0.13）mg·h^-1·L^-1、（2．87±0．38）mg·h^-1·L^-1。随着 DTX 血药浓度的升高，化疗的毒副作用程度加强（χ^2＝5．169、4．463、3．630，P ＝0．023、0．035、0．047）。B、C 组总有效率均为95．8％，高于 A 组的87.0％，差异无统计学意义（χ^2＝1．559，P ＝0.240）。结论DTX 的血药浓度在2．1-2．5 mg·h^-1·L^-1的乳腺癌患者疗效较好，且毒副反应能控制在一定程度内。

Objective To investigate the relationship between plasma docetaxel concentration and the efficacy as well as toxic and side effects in patients with breast cancer after chemotherapy.Methods Seventy -one patients with breast cancer who accepted AC sequential T chemotherapy regimen as first line treatment were selected from April 2015 to September 2015 in Hubei Provicial Tumor Hospital.The plasma concentration of docetaxel was detected by latex immunoturdidimetry after the docetaxel continuous infusion in each cycle.The three groups were assigned according to the concentration distribution of docetaxel：group A （plasma concentration docetaxel ≤ 2.0mg·h^-1 · L^-1 ）,group B （2.1 -2.5mg·h^-1 ·L^-1 ）and group C （≥2.6 mg·h^-1 ·L^-1 ）.The relationship between the drug plasma concentration,therapeutic efficacy and adverse reactions in different docetaxel plasma concentration was analyzed retrospectively by Chi -square tests.Results The average plasma concentrations of docetaxel of the three groups were （1.55 ±0.36）mg·h^-1 ·L^-1 ,（2.28 ±0.13）mg·h^-1 ·L^-1 ,（2.87 ±0.38）mg· h^-1 · L^-1 respectively.The adverse reactions were enhanced with the increasing of docetaxel plasma concentration （χ^2 =5.169, 4.463,3.630,P =0.023,0.035,0.047）.The therapeutic efficacy of group C and group B was same（95.8%）,which was higher than 87.0% of group A,but there was no statistically significant difference （χ^2 =1.559,P =0.24）. Conclusion Breast cancer patients whose plasma concentration of docetaxel is between 2.1 -2.5mg·h^-1 ·L^-1 has a better prognosis,and its adverse reactions are controlled in a certain extent.