聚乙二醇化重组人粒细胞集落刺激因子预防非小细胞肺癌患者多西他赛联合含铂方案化疗后骨髓抑制的效果观察

Effect of PEG-rhG-CSF on preventing bone marrow suppression in patients with non-small cell lung cancer after receiving TP chemotherapy

目的探讨聚乙二醇化重组人粒细胞集落刺激因子(PEG-rhG-CSF)预防非小细胞肺癌患者接受多西他赛联合洛铂(TP)方案化疗后骨髓抑制的疗效和安全性。方法回顾性分析清远市人民医院2018年4月至2020年3月治疗的年龄≥18岁、病理证实为非小细胞肺癌、术后接受TP方案化疗的非小细胞肺癌患者66例的临床资料。根据单个周期化疗后接受PEG-rhG-CSF、重组人粒细胞(rhG-CSF)的不同,分为观察组35例和对照组31例。观察组在化疗结束后48 h皮下注射PEG-rhG-CSF,6 mg/次。对照组在化疗结束后48 h皮下注射rhG-CSF,5μg·kg-1·d-1,直至外周血白细胞>10×109/L。比较两组预防骨髓抑制的效果。结果预防治疗后,两组治疗第1天、第3天、第5天,白细胞、中性粒细胞计数差异均无统计学意义(均P>0.05);两组治疗第10天,白细胞、中性粒细胞计数差异均有统计学意义(t=2.417、2.296,均P<0.05)。两组患者予以升白细胞处理后,观察组中性粒细胞减少发生率为40.00%(14/35),明显低于对照组的64.52%(20/31),差异有统计学意义(χ2=3.956,P=0.047)。观察组3、4级中性粒细胞减少发生率为2.86%(1/35),明显低于对照组的19.35%(6/31),差异有统计学意义(χ2=4.719,P=0.030)。两组疲劳、肌肉骨骼疼痛、注射部位疼痛发生率差异均无统计学意义(均P>0.05)。结论PEG-rhG-CSF用于预防非小细胞肺癌患者接受TP方案化疗后骨髓抑制,优于rhG-CSF的多次给药方案,可降低中性粒细胞减少发生率,为非小细胞肺癌患者辅助化疗后预防使用重组人粒细胞集落刺激因子提供了新的选择。

Objective To explore the efficacy and safety of PEGylated recombinant human granulocyte colony-stimulating factor(PEG-rhG-CSF)on preventing bone marrow suppression in patients with non-small cell lung cancer after receiving TP chemotherapy.Methods The clinical data of 66 cases who aged≥18 years old and pathologically confirmed as non-small cell lung cancer,received postoperative TP chemotherapy in Qingyuan People's Hospital from April 2018 to March 2020 were retrospectively analyzed.According to the difference between receiving PEG-rhG-CSF and rhG-CSF after a single cycle of chemotherapy,they were divided into observation group(n=35)and control group(n=31).In the observation group,PEG-rhG-CSF was injected subcutaneously 48 h after the end of chemotherapy,6 mg each time.In the control group,rhG-CSF was injected subcutaneously 48 h after the end of chemotherapy,5μg·kg-1·d-1,until the peripheral blood leukocytes were higher than 10×109/L.The effect of preventing bone marrow suppression was compared between the two groups.Results After the preventive treatment,there were no statistically significant differences in the counts of white blood cells and neutrophils between the two groups on the first day,the third day and the fifth day of treatment(all P>0.05).However,there were statistically significant differences on the tenth day(t=2.417,2.296,all P<0.05).The incidence of neutropenia in the observation group was 40.00%(14/35),which was significantly lower than that in the control group[64.52%(20/31)],the difference was statistically significant(χ2=3.956,P=0.047).The incidence of grade 3,4 neutropenia in the observation group was 2.86%(1/35),which was lower than that in the control group[19.35%(6/31)],the difference was statistically significant(χ2=4.719,P=0.030).There were no statistically significant differences in the incidence of bone pain,fatigue and injection site pain between the two groups(all P>0.05).Conclusion PEG-rhG-CSF is superior to rhG-CSF multiple-dose regimen in preventing bone marrow suppression in patients with non-small cell lung cancer after receiving TP chemotherapy,which can reduce the incidence of neutropenia and deficiency,and provide a new option for the preventive use of PEG-rhG-CSF after adjuvant chemotherapy in patients with non-small cell lung cancer.