消化道肿瘤患者5-氟尿嘧啶血药浓度监测对个体化治疗的影响

Effect of 5-fluorouracil blood concentration monitoring on individualized treatment in patients with gastrointestinal tumors

目的探讨消化道肿瘤患者5-氟尿嘧啶(5-Fu)血药浓度监测对个体化治疗的影响。方法选取2019年11月至2020年8月于东南大学附属中大医院收治的54例消化道肿瘤患者作为研究对象,采用随机数字表法将其分为对照组和研究组,每组各27例。两组均采用FOLFOX6方案进行化疗,两组在化疗的第1个周期,均以传统的基于体表面积(BSA)的方式给药,第2个周期开始到化疗结束,对照组仍以BSA方式给药,研究组则是在化疗第1个周期5-Fu的血药浓度及其药理参数(曲线下面积)的基础上,调整第2个周期到化疗结束后的用药剂量。比较两组化疗第4个周期5-Fu血药浓度的分布情况、化疗效果以及不良反应发生情况。结果两组5-Fu血药浓度分布占比比较,差异有统计学意义(P<0.05)。化疗4个周期后,研究组总体反应率高于对照组(P<0.05)。两组Ⅰ~Ⅱ级骨髓抑制、手足综合征及Ⅲ~Ⅳ级黏膜炎、手足综合征的发生率比较,差异无统计学意义(P>0.05);而研究组Ⅰ~Ⅱ级腹泻、胃肠道反应、黏膜炎及Ⅲ~Ⅳ级腹泻、胃肠道反应、骨髓抑制的发生率低于对照组,差异有统计学意义(P<0.05)。结论对消化道肿瘤患者进行5-Fu血药浓度监测可以为个体化治疗提供给药剂量依据,提高个体化治疗的化疗效果及降低其不良发应的发生率。

Objective To investigate the effect of 5-fluorouracil(5-Fu)blood concentration monitoring on individualized treatment in patients with gastrointestinal tumors.Methods A total of 54 patients with gastrointestinal tumors who were admitted to Zhongda Hospital Affiliated to Southeast University from November 2019 to August 2020 were selected as the research objects,they were divided into control group and study group by random number table method,with 27 cases in each group.Both groups were treated with FOLFOX6 regimen for chemotherapy.In the first cycle of chemotherapy,both groups were given the traditional body surface area(BSA)based chemotherapy.From the second cycle to the end of chemotherapy,the control group were still treated with BSA.In the study group,the dose of drug was adjusted from the second cycle to the end of chemotherapy based on the plasma drug concentration and pharmacological parameter(area under the curve)of 5-FU in the first cycle of chemotherapy.The distribution of 5-Fu plasma drug concentration,chemotherapy effect and adverse reactions between the two groups in the fourth cycle of chemotherapy were compared.Results There were significant difference in the proportion of 5-Fu plasma drug concentration distribution between the two groups(P<0.05).After four cycles of chemotherapy,the overall response rate of the study group was significantly higher than that of the control group(P<0.05).There was no significant difference in the incidence of grade Ⅰ-Ⅱ bone marrow suppression,and hand-foot syndrome,grade Ⅲ-Ⅳ mucositis,and hand-foot syndrome between the two groups(P>0.05);The incidence of grade Ⅰ-Ⅱ diarrhea,gastrointestinal reaction,mucositis,and grade Ⅲ-Ⅳ diarrhea,gastrointestinal reaction,and bone marrow suppression in the study group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Monitoring the plasma drug concentration of 5-Fu in patients with gastrointestinal tumors can provide dosage basis for individualized treatment,improve the chemotherapy effect of individualized treatment and reduce the incidence of adverse reactions.