混合核苷片预防乳腺癌表柔比星+环磷酰胺方案辅助化疗所致骨髓抑制的临床研究

Clinical study on the prevention of bone marrow suppression induced by AC chemotherapy with mixed nucleoside tablets of breast cancer patients

目的探讨乳腺癌病人表柔比星+环磷酰胺(AC)方案辅助化疗期间,使用混合核苷片预防骨髓抑制的临床效果。方法2018年1月~2019年12月我院行手术治疗后的乳腺癌病人84例,均使用AC(21天)方案行辅助化疗。将84例病人随机分为治疗组和对照组,每组各42例。对照组在AC方案化疗过程中若出现Ⅱ度及以上骨髓抑制,采用重组人粒细胞集落刺激因子注射液(recombinant human colony-stimulating factor,rh G-CSF)5μg/kg皮下注射。治疗组加用混合核苷片每次40 mg,每天3次。化疗开始后每周期d7、d9、d11进行血常规检查,分析两组病人放化疗期间血小板、白细胞和中性粒细胞计数变化情况、骨髓抑制程度、骨髓抑制出现时间及中性粒细胞减少症(febrile neutropenia,FN)出现次数。结果治疗前,两组病人血小板、白细胞、中性粒细胞比较差异无统计学意义(P>0.05),化疗结束后,两组血小板、白细胞、中性粒细胞计数均有不同程度地下降,差异有统计学意义(P<0.05)。与对照组比较,治疗组不同周期血小板、白细胞、中性粒细胞计数均有不同程度地增高。两组治疗后均有骨髓抑制出现,其中治疗组≥Ⅱ度骨髓抑制发生率为6.55%,对照组为13.10%,治疗组低于对照组,差异有统计学意义(P<0.05)。治疗组平均出现骨髓抑制反应时间晚于对照组[(9.8±1.1)天和(7.5±1.4)天,t=8.372,P=0.000)]。治疗组总共出现FN 2人/次,对照组总共出现FN 9人/次,治疗组出现FN次数较对照组少,差异有统计学意义(P<0.05)。结论混合核苷片可有效改善乳腺癌AC方案辅助化疗病人的骨髓抑制情况,减少FN的发生。在低危风险的乳腺癌AC方案中使用混合核苷片可能成为FN低风险化疗方案的新选择。

Objective To investigate the clinical effect of using mixed nucleoside tablets to prevent bone marrow suppression during AC adjuvant chemotherapy for breast cancer. Methods A total of 84 cases breast cancer patients who had received surgical treatment in our hospital from January 2018 to December 2019 were selected and all received adjuvant chemotherapy using AC regimen( 21 days). The patients were randomly divided into the treatment group( 42 patients) and the control group( 42 patients).In the control group,if degree Ⅱ or above bone marrow suppression occurred during chemotherapy,recombinant human granulocyte colony stimulating factor injection( rhG-CSF) 5 g/kg was administered subcutaneously. In the treatment group,mixed nucleoside tablets of 40 mg/time were given orally,3 times/d,during chemotherapy. The blood routine examination was conducted on the 7 th,9 th and 11 th day during4 periods of chemotherapy. Changes of platelet,white blood cell and neutrophil count,degree of bone marrow suppression,occurrence time of bone marrow suppression and occurrence times of FN were compared and analyzed between 2 groups. Results Before treatment,there was no significant difference in the platelets,white blood cells and neutrophils between 2 groups( P > 0. 05). After chemotherapy,the counts of platelets,white blood cells and neutrophils of 2 groups decreased( P < 0. 05) Compared with the control group,the counts of platelets,white blood cells,and neutrophils in the treatment group increased to varying degrees in 4 periods of chemotherapy. Bone marrow suppression occurred in both groups after chemotherapy. The incidence of bone marrow suppression in the treatment group was 6. 55%,and the control group was 13. 10%. The incidence of bone marrow suppression in the treatment group was lower than the control group( P < 0. 05). The average response time of bone marrow suppression in the treatment group was later than that in the control group [( 9. 8 ± 1. 1) d vs.( 7. 5 ± 1. 4) d,t = 8. 372,P = 0. 000) ].There were 2 people/period of FN in the treatment group,9 people/period in the control group,and fewer FNs in the treatment group than in the control group( P < 0. 05). Conclusion The mixed nucleoside tablets can effectively improve the myelosuppression of breast cancer patients with AC adjuvant chemotherapy and reduce the occurrence of FN. The use of mixed nucleoside tablets in AC adjuvant chemotherapy for low-risk breast cancer may become a new choice for FN low-risk adjuvant chemotherapy.