在肿瘤化疗中应用时机的临床研究

邵晓霞¹傅  冲²袁 涛¹  管继萍¹  任玉兰¹ 吴利伟¹

新疆克拉玛依市中心医院  邮编：834000

新疆克拉玛依市人民医院  邮编：834000

摘要：目的： 观察国产粒细胞刺激因子（立生素 G-CSF）在恶性肿瘤病人化疗过程中预防和治疗粒细胞减少的疗效。方法： 240例病人，分为3组。1组，61例，化疗前WBC<4.0*10q/L。用G-CSF 3-5mgKg^-1d^-1，至WBC升至正常范围维持一周后开始化疗，化疗结束后，24~48小时内，给予G-CSF，根据WBC计数连用7~14天；2组，81例，既往有因化疗而WBC减少史，该次化疗前WBC正常范围。化疗结束后，24~48小时应用G-CSF，连用7~14天，剂量同1组；3组，首次化疗病人，98例WBC正常范围，化疗结束后，每2天查WBC一次，当WBC<4.0*10q/L时，开始应用G-CSF，否则不用。

结果：1组7天内WBC减少者18例，14天仍未升至正常者8例；2组分别是19例，5例；3组分别是70例，23例。1，2两组与3组相比，其WBC降低例数明显减少（p<0.01），住院天数也明显缩短（P<0.01）。

讨论： 国产G-CSF(立生素)能够预防和治疗恶性肿瘤病人化疗阶段的粒细胞减少，尤其是既往有粒细胞减少史或多次化疗过的病人，化疗结束后应立即应用。首次化疗病人若化疗方案中含有紫杉醇类、铂类和长春碱类等药物时不应等待粒细胞减少时才应用。化疗期间发现粒细胞减少时应及时注射G-CSF，不应终止化疗。

关键词  粒细胞刺激因子（G-CSF）  恶性肿瘤   化疗

The clinical study about applying time when domestic G-CSF is applied for cancer chemotherapy

Summary:

Purpose: to observe the curative effect of which domestic G-CSF is used for severe cancer patients in the chemotherapy procedure to prevent and cure the reduction of granulocyte.  

Method: 240 patients are divided into 3 groups. 61 patients in group one, who’s WBC are less than 4.0*10q/L before chemotherapy. Start chemotherapy one week later after WBC up to normal when 3to 5mg Kg^-1d^-1 G-CSF applied. After chemotherapy procedure finished, uses G-CSF in 24 to 48 hours, and continues 7 to 14 days by WBC count. 81 patients are in group 2, who’s WBC are normal before this chemotherapy but had WBC reduction history because of chemotherapy. After chemotherapy procedure finished, uses G-CSF in 24 to 48 hours, and continues 7 to 14 days, the dosage same as group one. 98 patients are in group 3 with normal WBC. After chemotherapy procedure finished, checks out WBC every two days. Applies G-CSF if WBC are less than 4.0*10q/L, otherwise not.

Result: the number of patients whose WBC reduced in 7 days is 18 and WBC still not up to normal in 14 days is 8 in group one, which is 19 and 5 in group two and 70 and 23 in group three. Compare to group 3, the number of patients whose WBC reduced in group one and two are obviously less（P<0.01）, and the days patients staying in hospital are less too（P<0.01）.

Discussion: Domestic G-CSF can prevent and cure the reduction of granulocyte during severe cancer chemotherapy procedure, especially for the patients who have granulocyte reduction history or multi-chemotherapy history. G-CSF should be applied immediately after chemotherapy procedure finished. For the first-time-chemotherapy patients, G-CSF shouldn’t wait for granulocyte reduction to be applied if paclitaxel, Platinum and Vinblastin are used in chemotherapy procedure. G-CSF should be injected in time if granulocyte reduced in chemotherapy procedure, but chemotherapy shouldn’t be stopped.

Keyword: granulocyte-colony stimulating factor (G-CSF), severe cancer, chemotherapy