老年恶性肿瘤化疗患者网织红细胞参数的变化及临床意义

Changes and significance of reticulocyte parameters in elderly patients with malignant tumors undergoing chemotherapy

目的探讨老年恶性肿瘤化疗患者网织红细胞参数的变化及其临床意义。方法选取2016年1月至2019年10月在北京市海淀医院就诊的老年恶性肿瘤患者120例纳入研究组,另选取来我院体检的健康老年人60例纳入对照组。检测对照组受试者的白细胞(WBC)、血小板计数(PLT)、网织红细胞参数,以及研究组患者化疗前和化疗后3 d、1周、2周和3周的WBC、PLT、网织红细胞参数。结果研究组患者化疗前的高荧光强度的网织红细胞百分率(HFR%)和网织红细胞百分率(RET%)分别为(2.63±0.81)%和(1.44±0.41)%,明显大于对照组的(1.13±0.23)%和(1.10±0.32)%,差异均有统计学意义(P<0.05);两组受试者的中荧光强度的网织红细胞百分率(MFR%)、WBC和PLT值比较差异均无统计学意义(P>0.05);化疗后3 d,研究组患者的网织红细胞绝对数(RET)、未成熟网织红细胞指数(IRF)值分别为(0.51±0.04)×1012/L和(7.18±2.62)%,明显小于化疗前,且差异均有统计学意义(P<0.05);化疗后1周,研究组患者的RET和IRF值最低,分别为(0.16±0.02)×1012/L和(4.13±1.25)%,化疗后2周RET、IRF值回升,分别为(0.83±0.11)×1012/L和(8.69±2.37)%,化疗后1周和2周与化疗前比较差异均具有统计学意义(P<0.05),但化疗后3周,RET、IRF值恢复至化疗前水平,差异均无统计学意义(P>0.05);化疗后2周,研究组患者的PLT、WBC值达到最低,分别为(125.06±32.14)×109/L和(3.99±0.86)×109/L,与化疗前比较差异具有统计学意义(P<0.05);化疗后3周有所回升,与化疗前比较差异均无统计学意义(P>0.05)。结论网织红细胞参数可用来监测恶性肿瘤老年患者化疗后的骨髓造血功能的抑制作用,其中网织红细胞参数中RET和IRF在化疗后检测骨髓造血功能抑制以及恢复方面的敏感度更高,因此,在恶性肿瘤临床化疗治疗过程中,RET和IRF对治疗方案的调整、用药时机的选择具有指导意义。

Objective To investigate the changes and significance of reticulocyte parameters in elderly patients with malignant tumors undergoing chemotherapy.Methods A total of 120 elderly patients with malignant tumors,who admitted to Beijing Haidian Hospital from January 2016 to October 2019,were included in the study group,and 60 healthy elderly patients who came to Beijing Haidian Hospital for physical examination were included in the control group.White blood cells(WBC),platelet counts(PLT),and reticulocytes parameters of subjects in the control group were detected.WBC,PLT and reticulocytes parameters of the study group before chemotherapy and 3 days,1 week,2 weeks and 3 weeks after chemotherapy were detected,and the changes of relevant indicators were observed and recorded.Results The highly fluorescent reticulocyte(HFR)%and reticulocyte percentage(RET)%of subjects in the study group before chemotherapy were(2.63±0.81)%and(1.44±0.41)%,respectively,which were significantly larger than corresponding(1.13±0.23)%and(1.10±0.32)%(P<0.05).There was no significant difference in middle fluorescent reticulocyte(MFR)%,WBC and PLT between the two groups of subjects(all P>0.05).The RET and immature reticulocyte fraction(IRF)values of patients 3 days after chemotherapy in the study group were(0.51±0.04)×1012/L and(7.18±2.62)%,which were significantly lower than before chemotherapy(P<0.05).The lowest RET and IRF values of the subjects at one week after chemotherapy were(0.16±0.02)×1012/L and(4.13±1.25)%,and the RET and IRF values were respectively increased to(0.83±0.11)×1012/L and(8.69±2.37)%at two weeks after chemotherapy(P<0.05),both returned to pre-chemotherapy levels at 3 weeks after chemotherapy.The WBC and PLT value reached the lowest at 2 weeks after chemotherapy respectively(125.06±32.14)×109/L and(3.99±0.86)×109/L(P<0.05),and it started to increase at 3 weeks after chemotherapy,and there was no significant difference compared with before chemotherapy(P>0.05).Conclusion Reticulocyte parameters can be used to monitor the inhibitory effect of bone marrow hematopoietic function in elderly patients with malignant tumors after chemotherapy.Among them,RET and IRF in the reticulocyte parameters are more sensitive in detecting bone marrow hematopoietic function inhibition and recovery after chemotherapy.Therefore,RET in the process of clinical chemotherapy for malignant tumors,IRF and IRF have guiding significance for the adjustment of treatment plan and the choice of drug timing.