摘要
目的比较不同升血小板药物治疗实体瘤化疗所致血小板减少症(chemotherapy induced thrombocytopenia,CIT)的疗效,探讨CIT的治疗药物选择。方法回顾性分析复旦大学附属肿瘤医院2014年5月至2015年4月化疗后血小板计数低于100×10~9·L^(-1)的实体瘤患者。按治疗方式分组,分析重组人白介素11(rhIL-11)组、重组人血小板生成素(rhTPO)组、两药联合组以及未治疗组血小板恢复率、恢复时间以及复发率的差异,P<0.05认为有统计学意义。结果共纳入281例患者。各等级CIT中,不同干预方式CIT恢复率未见显著性差异(组间两两比较,P值均大于0.05)。不同等级CIT中,各干预组的恢复时间相似,均为6~7 d(组间两两比较,P>0.05);仅在Ⅲ度CIT中,联用组恢复时间快于两个单药组(5.5 d vs 7 d),但差异无显著性(联用组vs rhIL-11组、rhTPO组,P值分别为0.609和0.605)。从CIT复发率上看,治疗组复发率高于未治疗组,rhTPO组复发率高于rhIL-11组。Ⅱ度CIT中,rhTPO组和rhIL-11组的复发率均显著高于未治疗组(35%,38%vs 0%,P=0.008,P=0.006);Ⅲ度CIT中,rhTPO组复发率显著高于rhIL-11组(55%vs 21%,P=0.017)。结论Ⅰ~Ⅱ度CIT不推荐使用升血小板药物治疗;Ⅲ~Ⅳ度CIT,不同干预方式的疗效上未见显著差异,成本角度考虑,推荐单药rhIL-11。
OBJECTIVE To compare the efficacy of different interventions on chemotherapy induced thrombocytopenia （CIT） in solid tumors. METHODS Patients, registered at Fudan University Shanghai Cancer Center, who developed CIT （defined as platelet count 〈 100 x 10^9 · L-1 ） during May 2014 and April 2015 were retrospectively enrolled. The patients were divided into recombinant human interleukin 11 （ rhIL-11 ） group, recombinant human thrombopoietin （ rhTPO ） group, combination group and non-treatment group. Complete remission rate （CR） , recovery time and recurrence rate were calculated to compare the efficacy of interventions. P 〈 0. 05 was considered as statistical significant. RESULTS A total of 281 eligible patients were enrolled. No significant difference were found on recovery rate of different interventions in each grade of CIT （ P 〉 0. 05 ）. Recovery time were similar between interven- tions, most group had a median recovery time of 6 or 7 d. In grade m CIT, the recovery time of combination group is shorter than the other intervention groups （5.5 d in combination group vs 7 d in rhTPO group and rhIL-11 group） , but there was no significant differ- ence （ P = 0. 609, 0. 605 ）. In grade IICIT, the recurrence rate was significantly higher in rhTPO group and rhIL-11 group than un- treated group （35% , 38%0 vs 0% , P =0. 008, P =0. 006）. In grade 1I CIT, the recurrence rate of rhTPO group was significantly higher than that of rhIL-11 group （55 % vs 21% , P = O. 017 ）. CONCLUSION The result of the current study suggests that throm- bopoietie agents are not recommended for patients with I - II CIT. For m - IV CIT, no significant differences are found in the effica- cy between different interventions, thus rhIL-11 is recommended in consideration of cost.
作者
李焕
刘洪悦
张志圣
余波
翟青
LI Huan1＇2＇3 , LIU Hong-yue1＇2, ZHANG Zhi-sheng1＇2＇3, YU Bo1＇2, ZHAI Qing1＇2.(1. Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2. Department of Oncology, Shanghai Medical College, Fudan Universi- ty, Shanghai 200032, China; 3. School of Pharmacy, Fudan University, Shanghai 201203, Chin)
出处
《中国药学杂志》
CAS
CSCD
北大核心
2018年第6期467-471,共5页
Chinese Pharmaceutical Journal
