益生菌在卡培他滨联合吡咯替尼治疗晚期乳腺癌中的作用探讨

The Effect of Probiotics on the Efficacy and Adverse Reactions of Breast Cancer Chemotherapy Combined with Targeted Therapy

目的:探究益生菌对吡咯替尼联合卡培他滨治疗人表皮生长因子受体2(HER-2)阳性晚期乳腺癌的临床疗效及不良反应,以期为临床制定治疗方案提供参考。方法:选取2019年1月至2023年8月广西医科大学附属肿瘤医院105例HER-2阳性乳腺癌患者,以随机数字表法分为研究组和对照组,例数分别为53例、52例。研究组行益生菌^(+)吡咯替尼^(+)卡培他滨治疗,对照组行吡咯替尼^(+)卡培他滨治疗。比较两组近期疗效、化疗前后主要肠道菌群菌落数、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、炎性因子[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤细胞坏死因子-α(TNF-α)]、癌因性疲乏程度[Piper疲乏量表(Piper Fatigue Scale,PFS)评分]、睡眠质量[匹兹堡睡眠质量指数(PSQI)评分]、生活质量[欧洲癌症研究与治疗组织生活质量核心量表(EORTC QLQ-C30)评分]及不良反应。结果:两组总缓解率比较,差异无统计学意义(P>0.05),但研究组因不良反应停用或降低吡咯替尼剂量率低于对照组(P<0.05);研究组治疗2周期后、4周期后双歧杆菌、乳酸杆菌菌落数高于对照组,大肠杆菌、肠球菌菌落数低于对照组(P<0.05);研究组治疗2周期后、4周期后外周血CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组(P<0.05);研究组治疗2周期后、4周期后血清IL-6、IL-8、TNF-α水平低于对照组(P<0.05);研究组化疗2周期后、4周期后PFS、PSQI评分低于对照组,EORTC QLQ-C30评分高于对照组(P<0.05);研究组腹泻发生率低于对照组(P<0.05),手足综合征、白细胞减少、中性粒细胞减少、血小板减少发生率与对照组比较差异无统计学意义(P>0.05)。结论:益生菌可促进HER-2阳性乳腺癌患者在接受吡咯替尼联合卡培他滨治疗后免疫功能改善,可有效减少消化道相关不良反应发生,从而提高患者生存质量。

Objective:To explore the clinical efficacy and adverse reactions of probiotic combination with pyrotinib and capecitabine for the treatment of HER-2 positive advanced breast cancer,with a view to providing a reference for clinical treatment plans.Methods:One hundred and five HER-2 positive breast cancer patients were selected from January 2019 to August 2023 in the Affiliated Tumor Hospital of Guangxi Medical University and were divided into the study group and the control group by randomized numerical table method,and the numbers of cases were 53 and 52,respectively.The study group was treated with probiotics^(+)pyrotinib^(+)capecitabine,and the control group was treated with pyrotinib^(+)capecitabine.The two groups were compared in terms of recent efficacy,the number of major intestinal flora colonies before and after chemotherapy,T-lymphocyte subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8),and tumor cell necrosis factor-alpha(TNF-alpha)],and the degree of cancer-caused fatigue[Piper Fatigue Scale(PFS)score],sleep quality[Pittsburgh Sleep Quality Index(PSQI)score],quality of life[European Organization for Research and Treatment of Cancer Quality of Life questionmaire core 30(EORTC QLQ-C30)score],and adverse effects.Results:The total remission rate of the two groups was not statistically significant(P>0.05),but the rate of discontinuing or lowering the dose of pyrotinib due to adverse reactions was lower in the study group than in the control group(P<0.05);the number of bifidobacteria and Lactobacillus colonization was higher than that of the control group,and the number of Escherichia coli and enterococci colonization was lower than that of the control group after 2 cycles of treatment in the study group,and 4 cycles later(P<0.05);the number of peripheral blood CDs was higher than that of the control group after 2 cycles of treatment in the study group.After 2 cycles of treatment,peripheral blood CD3^(+),CD4^(+),CD4^(+)/CD8^(+)levels were higher than those of the control group(P<0.05);serum IL-6,IL-8,TNF-αlevels were lower than those of the control group after 2 cycles of treatment and after 4 cycles of treatment in the study group(P<0.05);PFS and PSQI scores were lower than those of the control group after 2 cycles of chemotherapy and after 4 cycles of chemotherapy in the study group,and EORTC QLQ-C30 score was higher than that of the control group(P<0.05);the incidence of diarrhea in the study group was lower than that of the control group(P<0.05),and the difference in the incidence of hand-foot syndrome,leukopenia,neutropenia,and thrombocytopenia was not statistically significant when compared with that of the control group(P>0.05).Conclusion:Probiotic can promote the improvement of immune function in HER-2 positive breast cancer patients after treatment with pyrotinib combined with capecitabine,which can effectively reduce the occurrence of gastrointestinal-related adverse reactions,thus improving the quality of patient survival.