宫颈癌化疗血管毒性防治的研究

Study of prophylaxis and treatment of the vascular toxicity of chemotherapy for cervical carcinoma

目的观察和评价宫颈癌化疗患者血管毒性干预的效果。方法采用间断时间序列(interrupted time series,ITS)设计。选择宫颈癌化疗患者30例,行问卷调查、临床检查,检测血管标志物hsCRP、s E-selectin、s ICAM-1、v WF、ET-1和s TM,评价血管风险(无、低、高),施三级预防措施,包括膳食、锻炼、心理、调整血压、血糖、使用血管保护药物和调整化疗药量等干预,开始化疗、在化疗中和结束后监测并评价血管毒性(0~5级),根据需要进一步采取上述干预或停药。建立ITS线性回归模型,分析干预实施前后血管毒性发生率的变化趋势。结果干预后hs-CRP、s E-selectin、s ICAM-1和v WF呈下降趋势(P <0. 05),而ET-1和s TM均P> 0. 05; ITS模型显示,干预后血管毒性发生率有下降趋势,但未达到具有统计学意义的程度。结论综合三级预防措施可以使多数所检测的血管标志物发生有益于患者的变化,ITS模型的结果显示未见统计学意义,有必要扩大样本含量进一步研究。

Objective To observe and evaluate the effectiveness of interventions of the vascular toxicities of chemotherapy for cervical cancer. Methods The interrupted time series （ITS） design was adopted. Thirty patients with cervical cancer were collected. The subjects were in- terviewed with the predesigned questionnaires, and performed clinical examinations. And the vascular markers of hs-CRP, sE-seleetin, sICAM-1, vWF, ET-1 and sTM were tested. Then, the vascular risk （no, low, high） were appraised, and primary, secondary, and tertiary pre- ventive interventions were taken including diet, exercise, psychological intervention, manage- ment of blood pressure and blood sugar, use of vascular protective drugs and dosage adjust-ment. Vascular toxicities （ grade 0 - 5 ） of the subjects were monitored and evaluated, and the above interventions or drug withdrawal were taken according to the actual clinical requirements during and after chemotherapy. The trends in the incidence of vascular toxicities before and af- ter the interventions were analyzed by using an ITS linear regression model. Results The lev- els of hs-CRP, sE-selectin, sICAM-1, and vWF decreased after interventions （P 〈 0. 05 ）, and the changes of levels of ET-1 and sTM were not statistically significant （P 〉 0. 05 ）. The ITS model showed that the incidence of vascular toxicity descended after interventions, but not sta- tistically significant. Conclusion Most of the detected vascular markers are beneficial to the patients with the comprehensive three-stage preventive measures, ITS former showed no statisti- cally significance, it is necessary to expand the sample size for further study.