聚乙二醇化重组人粒细胞刺激因子在儿童肝母细胞瘤术后化疗中对中性粒细胞减少的预防效果

Effect of pegylated recombinant human granulocyte colony stimulating factor on the prevention of neutropenia in postoperative chemotherapy of hepatoblastoma in children

目的探究聚乙二醇化重组人粒细胞集落刺激因子(pegylated recombinant human granulocyte colony stimulating factor,PEG-rhG-CSF)在儿童肝母细胞瘤术后化疗中对中性粒细胞减少的预防效果。方法选取2017年2月至2019年2月于首都医科大学附属北京同仁医院就诊的肝母细胞瘤患儿60例为研究对象,随机将其分为观察组和对照组,每组30例。所有患儿均接受4周期相同方案化疗,观察组患儿予皮下注射PEG-rhG-CSF 100μg/kg,1次/周期,对照组患儿予皮下注射重组人粒细胞刺激因子(recombinant human granulocyte colony stimulating factor,rhG-CSF)5μg/kg,1次/d。治疗期间监测患儿血常规并记录中性粒细胞绝对值(absolute neutrophil count,ANC),比较两组患儿的临床治疗效果、抗生素使用率、化疗后中性粒细胞减少性发热(febrile neutropenia,FN)的发生情况和药物相关不良反应。结果两组患儿ANC<1.5×10^9/L发生率、ANC<0.5×10^9/L发生率、ANC<0.5×10^9/L持续时间、ANC由最低点恢复至≥2.0×10^9/L所需时间比较均无统计学意义(均P>0.05)。用药后,观察组和对照组患儿ANC的最低值分别出现在第11天和第9天,分别为(3.0±2.0)×10^9/L和(2.1±1.5)×10^9/L,比较差异均无统计学意义(均P>0.05),但观察组患儿ANC变动幅度较小,化疗周期末ANC数值相对较高。两组患儿FN发生率、抗生素使用率、不良反应发生率比较均无统计学意义(均P>0.05)。结论PEG-rhG-CSF 1次给药与rhG-CSF连续多次给药在治疗儿童肝母细胞瘤术后化疗致中性粒细胞减少的疗效相当,不良反应较少。

Objective To investigate the preventive effect of pegylated recombinant human granulocyte colony stimulating factor(PEG-rhG-CSF)on neutropenia in postoperative chemotherapy of pediatric hepatoblastoma.Method A total of 60 pediatric patients with hepatoblastoma who admitted Beijing Tongren Hospital Affiliated to Capital Medical University from February 2017 to February 2019 were selected as research objects and randomly divided into observation group and control group,with 30 patients in each group.All children received 4 cycles of chemotherapy with the same regimen.Children in observation group were given subcutaneous injection of 100μg/kg PEG-rhG-CSF once per cycle,and children in control group were given subcutaneous injection of 5μg/kg recombinant human granulocyte colony stimulating factor(rhG-CSF)once a day.During the treatment,blood routine of the children was monitored and absolute neutrophil count(ANC)was recorded.Clinical treatment effect,antibiotic usage rate,febrile neutropenia(FN)after chemotherapy and drug-related adverse reactions were compared between the two groups.Result There were no statistically significant differences in the incidence of ANC<1.5×10^9/L,the incidence of ANC<0.5×10^9/L,ANC<0.5×10^9/L duration,and ANC recovery time from the lowest point to≥2.0×10^9/L between the two groups(all P>0.05).The lowest ANC values of children in observation group and control group appeared on the 11^th and 9^th days respectively,which were(3.0±2.0)×10^9/L and(2.1±1.5)×10^9/L respectively,with no statistically significant difference(all P>0.05),but the ANC of children in observation group changed slightly,and the ANC at the end of the chemotherapy cycle was relatively high.There were no statistically significant differences in FN incidence,antibiotic utilization rate and adverse reaction incidence between the two groups(all P>0.05).Conclusion One dose of PEG-rhG-CSF has the same effect as several consecutive doses of rhG-CSF in the treatment of pediatric hepatoblastoma chemotherapy induced neutropenia,with few adverse reactions.