甘露醇对非小细胞肺癌脑转移患者脑部顺铂浓度的影响  

Effect ofmannitol on the permeability of Cis-diamminedichloroplatinum into blood-brain barrier in NSCLC patients

作　　者：魏然[1] 贾金广 朱婉凌[1] 王敏[1] 忽新刚[2] WEI Ran1,JIA Jinguang1 ,ZHU Wanling1,WANG Min1, HU Xingang2(1. Respiratory Medical Department, People＇s Hospital of Zhengzhou , Zhengzhou 450053, China ; 2.Respiratory Medical Department, Henan Provincial People＇s Hospital ,Zhengzhou 450003, Chin)

机构地区：[1]郑州人民医院呼吸内科,河南郑州450053 [2]河南省人民医院呼吸内科,河南郑州450003

出　　处：《中国实用神经疾病杂志》2018年第6期622-625,共4页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学教育研究课题(Wjlx2017046)

摘　　要：目的观察甘露醇对非小细胞肺癌多发脑转移患者脑脊液中顺铂(DDP)浓度的影响,探讨甘露醇对DDP透过血脑屏障的作用。方法 60例ⅢB?Ⅳ期非小细胞肺癌(NSCLC)脑转移患者,随机分为A、B、C 3组。A组在DDP治疗开始前30min给予甘露醇,B组在DDP治疗开始前2h给予甘露醇,C组单纯使用DDP治疗。分别于DDP治疗后3h采集脑脊液与血标本,检测DDP浓度。参考KPS评分及症状评价患者生活质量、近期客观疗效以及不良反应。结果 3组脑脊液DDP浓度分别为:A组(2.82±1.46)mg/L,B组(1.24±1.11)mg/L,C组(1.03±0.92)mg/L,各组比较差异有统计学意义(P<0.05)。3组KPS评分分别为:A组(66.82±7.31)分,B组(58.54±7.5)分和C组(42.29±8.73)分,各组比较差异有统计学意义(P<0.05)。无进展生存期3组情况:A组(11.46±4.35)个月、B组(9.29±4.61)个月和C组(7.39±3.12)个月,生存期分别为A组(18.75±5.63)个月、B组(16.82±3.73)个月和C组(13.09±4.24)个月,各组比较差异有统计学意义(P<0.05)。3组不良反应发生率分别为63.5%、65.2%和64.3%,组比较差异无统计学意义(P>0.05)。结论甘露醇可以促进DDP透过血脑屏障,且提前30min使用时效果更明显;甘露醇联合DDP治疗NSCLC脑转移患者,可提高疗效,改善患者的预后及生活质量,延长总生存时间,不良反应未增加。Objectives To investigate the effect of mannitol on blood-brain barrier guantitatively by measuring cis-diammin edichloroplatinum （DDP） concentration in cerebrospinaI fluid （CSF）. Methods Sixty patients with brain metastases from non- small cell lung cancer （NSCI.C） were randomly divided into 3 groups： A,B, C. Group A was given mannitol 30 rains before the DDP treatment,group B was given mannitol 2 hrs before the DDP treatment,group C was given DDP without mannitol. The CSF and blood samples were then collected and the DDP level was assayed by flameless atomic absorption speetrophotometry. Prognosis of three groups was evaluated. Results The average DDP level in CSF of three groups were A gourp （2.82±1.46）mg/ L,B group （1.24±1.11） mg/L,and C gourp （1.03±0.92） mg/L. The KPS score after treatment in three groups were A group （66.82±7.31） ,B gourp （58.54±7.5） ,and C gourp （42.29±8.73）. The progression free survival time in three groups were A group （11.46±4.35） months, B gourp （9.29±4.61） months, C gourp （7.39±3.12） months. The survival months in three groups were A group （]8.75±5.63） months,B gourp （16.82±3.73） months,C gourp （13.09±4.24） months. The incidences of side effects in the three groups were 63.5%,65.2% and 64.3 % each. Conclusion Mannitol can improve the permeability of DDP through blood-brain barrier in NSCLC patients with brain metastases especially being used 30min earlier. The combination therapy of mannitol and DDP could improve the curative effect and the prognosis of patients with prolonging the survival time,without increasing the occurrence of adverse reactions.

关 键 词：甘露醇 血脑屏障 顺铂 脑肿瘤/转移性 非小细胞肺癌 

分 类 号：R734.2[医药卫生—肿瘤]