鼻咽癌和宫颈癌患者同步放化疗单核细胞减少与中性粒细胞减少症关系

Relationship between monocytopenia and neutropenia during concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma and cervical cancer

目的评估鼻咽癌和宫颈癌患者外周血单核细胞计数下降是否为预测中性粒细胞减少症发生的潜在指标。方法回顾分析2017—2018年在苏州大学附属第二医院接受调强放疗联合紫杉醇脂质体和铂类同步化疗并发生中性粒细胞减少的鼻咽癌和宫颈癌患者的病历资料。采用配对样本t检验评估单核细胞最初下降、下降到最低水平、最终增加到正常值的天数是否显著少于中性粒细胞相应变化时间。此外,对中性粒细胞数目绝对值(ANC)减少程度和基线单核细胞数目绝对值(AMC)关联性进行χ2检验。结果两周期同步化疗AMC的变化趋势与ANC的变化趋势均一致,AMC最初下降、下降到最低水平、最终增加到正常值的天数明显少于ANC(4 d∶6 d、4 d∶10 d、10 d∶16 d,P<0.001;5 d∶6 d、6 d∶9 d、7 d∶12 d,P<0.001;),但并未发现单核细胞基线值与随后发生的中性粒细胞减少症的严重程度具有相关性[(AMC<0.4×10^(9))∶(AMC≥0.4×10^(9))=32∶63,P=0.172]。结论单核细胞计数减少是预测中性粒细胞减少发生的重要潜在指标,也是指导下次监测中性粒细胞计数时间及使用粒细胞集落刺激因子治疗的重要指标。

Objective To evaluate whether the decrease in peripheral blood monocyte count was a potential predictor for neutropenia in patients with nasopharyngeal carcinoma and cervical cancer.Methods The medical records of 95 patients with nasopharyngeal carcinoma and cervical carcinoma who received intensity-modulated radiation therapy(IMRT)combined with paclitaxel liposomes and platinum(TP)synchronous chemotherapy and presented with neutropenia in the Second Affiliated Hospital of Soochow University from January 2017 to December 2018 were retrospectively analyzed.Paired sample t-test was used to assess whether the number of days when the monocytes initially dropped/decreased to lowest level/eventually increased to normal value was significantly less than those of the neutrophils.In addition,the chi-square test was performed to determine the correlation between the degree of reduction in the absolute neutrophil count(ANC)and baseline absolute monocyte count(AMC).Results The change trend of AMC was consistent with that of ANC in the two cycles of concurrent chemotherapy.The number of days when AMC initially decreased/decreased to the lowest level/finally increased to normal value was significantly less than that of ANC(4 d vs.6 d,4 d vs.10 d,P<0.001;5 d vs.6 d,6 d vs.9 d,7 d vs.12 d,P<0.001).However,no correlation was found between the baseline level of monocytes and the degree of subsequent neutropenia[(AMC<0.4×10^(9))vs.(AMC≥0.4×10^(9))=32 vs.63,P=0.172].Conclusions Decreased monocyte count is an important potential predictor for neutropenia and a significant indicator for guiding the next monitoring of neutrophil count and treatment with granulocyte colony-stimulating factor.