预防性使用重组人粒细胞刺激因子对神经母细胞瘤患儿化疗后骨髓抑制的影响

Effects of prophylactic use of recombinant human granulocyte colony stimulating factor on myelosuppression in children with neuroblastoma after chemotherapy

目的探究预防性使用重组人粒细胞刺激因子(rhG-CSF)对神经母细胞瘤(NB)患儿化疗后骨髓抑制的影响。方法选取2020年6月-2022年7月在南京医科大学附属儿童医院确诊的66例NB患儿,采用随机数表法将NB患儿分为预防组(33例)和对照组(33例)。2组患儿第一化疗周期均采用环磷酰胺+托泊替康的化疗方案,预防组在化疗开始24~48 h后立即预防性使用rhG-CSF,对照组在出现粒细胞缺乏后再给予rhG-CSF进行治疗。比较预防组和对照组患儿白细胞计数(WBC)、中性粒细胞绝对计数(ANC)、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)水平和WBC、ANC恢复正常的时间,观察2组患儿继发感染发生率和不良反应发生率。结果治疗后,预防组WBC、ANC水平分别为(5.65±2.41)×10^(9)/L、(6.22±2.34)×10^(9)/L,均高于对照组的(3.91±2.32)×10^(9)/L、(4.45±1.12)×10^(9)/L,差异有统计学意义(P<0.05);预防组IFN-γ、TNF-α水平分别为(6.91±1.41)μg/L、(12.22±2.34)ng/L,低于对照组的(10.42±2.12)μg/L、(19.45±1.62)ng/L,差异有统计学意义(P<0.05);预防组WBC、ANC恢复正常时间分别为(5.56±0.86)d、(5.52±0.82)d,均短于对照组的(7.21±1.21)d、(7.43±1.25)d,差异有统计学意义(P<0.05);预防组继发感染发生率(21.21%)低于对照组(46.88%),差异有统计学意义(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论rhG-CSF能改善NB患儿化疗后引起的骨髓抑制,预防性使用更能明显减轻NB化疗后骨髓抑制,减少继发性感染,具有一定的临床预后改善价值。

Objective To explore the effects of prophylactic use of recombinant human granulocyte colony stimulating factor(rhG-CSF)on myelosuppression in children with neuroblastoma(NB)after chemotherapy.Methods A total of 66 children with NB confirmed in the hospital were enrolled between June 2020 and July 2022.According to random number table method,they were divided into prevention group(33 cases)and control group(33 cases).During the first chemotherapy,both groups were given the chemotherapy regimen(cyclophosphamide+topotecan).The prevention group was given prophylactic use of rhG-CSF immediately after 24-48h of chemotherapy,while control group was given rhG-CSF after agranulocytosis.The levels of white blood cell count(WBC),absolute neutrophil count(ANC),interferon-γ(IFN-γ)and tumor necrosis factor-α(TNF-α),recovery time of WBC and ANC in the two groups were compared.The incidence of secondary infection and adverse reactions in both groups was observed.Results After treatment,levels of WBC and ANC in prevention group were(5.65±2.41)×10^(9)/L and(6.22±2.34)×10^(9)/L,higher than those in control group[(3.91±2.32)×10^(9)/L,(4.45±1.12)×10^(9)/L,P<0.05].The levels of IFN-γand TNF-αin prevention group were(6.91±1.41)μg/L and(12.22±2.34)ng/L,lower than those in control group[(10.42±2.12)μg/L,(19.45±1.62)ng/L,P<0.05].The recovery time of WBC and ANC in prevention group was(5.56±0.86)d and(5.52±0.82)d,shorter than that in control group[(7.21±1.21)d,(7.43±1.25)d,P<0.05].The incidence of secondary infection in prevention group was lower than that in control group(21.21%vs 46.88%,P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The rhG-CSF can improve myelosuppression in NB after chemotherapy.The prophylactic useof rhG-CSF can more significantly relieve myelosuppression and reduce secondary infection,with certain clinical prognostic value.