口服谷氨酰胺预防奥沙利铂神经毒性的疗效观察  

Effect of Oral Glutamine on Oxaliplatin-induced Neurotoxicity

作　　者：黄世锋[1] 陈德伦[1] 宋学民[1] 

机构地区：[1]广西柳州市工人医院普外科,545005

出　　处：《中国全科医学》2009年第18期1716-1718,共3页Chinese General Practice

摘　　要：目的观察晚期结直肠癌患者口服谷氨酰胺(glutamine,Gln)预防奥沙利铂(oxaliplatin,L-OHP)神经毒性的疗效。方法将82例晚期结直肠癌患者随机分为试验组(40例)和对照组(42例)。两组均采用FOL-FOX4方案化疗:L-OHP85mg/m2静脉滴注2h;亚叶酸钙(CF)200mg/m2静脉滴注2h;同时5-氟尿嘧啶(5-FU)400mg/m2于CF静脉滴注完毕后静脉注射10min,随后5-FU600mg/m222h持续泵入,第1、2天,每2周为1个疗程,4周为1周期。试验组于每疗程静脉滴注L-OHP当天开始口服左旋Gln颗粒15g,2次/d,连用7d。化疗6个周期后进行外周感觉神经毒性及临床疗效评价。结果试验组外周感觉神经毒性总发生率为47.5%,其中Ⅲ～Ⅳ级发生率为10.0%;对照组外周感觉神经毒性总发生率为71.4%,其中Ⅲ～Ⅳ级发生率为31.0%,两组外周感觉神经毒性总发生率及Ⅲ～Ⅳ级神经毒性发生率间差异均有统计学意义(χ2值分别为4.88和5.47,P值分别为0.03和0.02)。治疗后试验组完全缓解3例,部分缓解14例,稳定15例,进展8例,有效率为42.5%;对照组完全缓解4例,部分缓解16例,稳定13例,进展9例,有效率为47.6%。两组患者临床疗效间差异无统计学意义(Z=0.31,P=0.76)。结论晚期结直肠癌患者口服Gln能有效预防L-OHP导致的周围神经毒性,且不影响L-OHP的抗肿瘤活性。Objective To assess the efficacy of oral glutamine in preventing neurotoxicity induced by oxaliplatin in patients with advanced colorectal carcinoma （ACC）. Methods Eighty- two ACC patients were randomly divided into groups experiment （ n = 40） and control （ n = 42 ）. FOLFOX4 chemotherapy were used in both groups ： L - OHP, 85 mg/m^2, iv gtt, 2h; calcium folinate （CF）, 200 mg/m^2, iv gtt, on day 1, 2, 5 -fluorouracil （5 -FU）, 400 mg/m^2, iv gtt following CF, 10 min, and at the same time continuous infusion of 5 - FU, 600 mg/m^2 , 22 h, taking 2 weeks as a course of treatment, 4 weeks as a cycle. Experiment group received orally Gin particles, 15 g, twice/d, 7 d, on the day when intravenous L - OHP started in every course. Peripheral sensory nerve toxicity and clinical effect were determined after 6 cycles of chemotherapy. Results The total incident rate was lower in experiment group than in control （47.5 % vs 71.4% P = 0. 03 ）, and the incidence of grade Ⅲ, Ⅳ neurotoxicity was also lower （ 10% vs 30. 95% P =0. 02）. There was not significant difference in efficiency between 2 groups （42. 5% vs47.6.4% P =0. 76） ）. Conclusion Oral glutamine can effectively prevent peripheral neurotoxicity due to L - OHP, not influencing the antineoplasmic activity of L - OHP.

关 键 词：结直肠肿瘤 谷氨酰胺 奥沙利铂 抗肿瘤联合化疗方案 

分 类 号：R735.3[医药卫生—肿瘤] R745[医药卫生—临床医学]