不同剂量培美曲塞鞘内灌注用于肺癌脑膜转移的疗效和毒性观察  

Observation on the efficacy and toxicity of intrathecal infusion of pemetrexed with different doses for meningeal metastasis of lung cancer

作　　者：周毅 ZHOU Yi(Department of Tumor Interventional Hematology,The People's Hospital of Zhijin County,Zhijin 552100,China)

机构地区：[1]织金县人民医院肿瘤介入血液科,552100

出　　处：《中国现代药物应用》2025年第2期63-66,共4页Chinese Journal of Modern Drug Application

摘　　要：目的 观察不同剂量培美曲塞鞘内灌注用于肺癌脑膜转移的疗效及毒性。方法 选择74例肺癌脑膜转移患者,分别使用10、30、50、80 mg剂量梯度[10 mg组(26例)、30 mg组(25例)、50 mg组(17例)、80 mg组(6例)]进行培美曲塞鞘内灌注化疗,起始剂量均为10 mg。比较四组灌注前后疗效指标[卡氏评分(KPS)、头痛疼痛数字评分法(NRS)评分、脑脊液癌胚抗原(CEA)、脑脊液细胞学(+)率]及血液学毒性指标[白细胞计数(WBC)、血小板计数(PLT)],灌注后神经根反应。结果 10、30、50 mg组灌注后的KPS评分分别为(58.19±10.69)、(60.53±9.77)、(64.86±9.04)分,高于灌注前,差异有统计学意义(P<0.05)。10、30、50、80 mg组灌注后的头痛NRS评分分别为(4.3±1.9)、(3.1±1.3)、(2.1±0.9)、(2.0±0.6)分,低于灌注前,差异有统计学意义(P<0.05)。30、50 mg组灌注后的脑脊液CEA分别为(31.82±8.67)、(19.66±6.15)mg/ml,低于灌注前,差异有统计学意义(P<0.05)。50 mg组灌注后的脑脊液细胞学(+)率17.6%(3/17)低于灌注前,差异有统计学意义(P<0.05)。四组灌注后神经根反应阳性率比较,差异无统计学意义(P>0.05)。50 mg组灌注后的WBC(4.8±1.3)×10^(9)/L、PLT(141.3±17.6)×10^(9)/L低于灌注前,差异有统计学意义(P<0.05)。结论 培美曲塞50 mg鞘内灌注既能显著消除癌细胞又能迅速缓解症状,安全性可控。Objective To observe the efficacy and toxicity of intrathecal infusion of pemetrexed with different doses for meningeal metastasis of lung cancer.Methods 74 patients with meningeal metastasis of lung cancer were selected for intrathecal infusion chemotherapy using dose gradients of 10,30,50 and 80 mg[10 mg group (26 cases),30 mg group (25 cases),50 mg group (17 cases) and 80 mg group (6 cases)],with an initial dose of 10 mg.The efficacy indexes[Karnofsky performance scale (KPS) score,numerical rating scale (NRS) score,carcinoembryonic antigen (CEA),cerebrospinal fluid cytology (+) rate],hematological toxicity indexes[white blood cell count (WBC),platelet count (PLT)]before and after perfusion,and nerve root reaction after perfusion among the four groups were compared.Results KPS scores of 10,30 and 50 mg groups were (58.19±10.69),(60.53±9.77) and (64.86±9.04) points after perfusion,which were higher than that before perfusion,and the difference was statistically significant (P<0.05).NRS scores of 10,30,50 and 80 mg groups were (4.3±1.9),(3.1±1.3),(2.1±0.9) and (2.0±0.6) points after perfusion,which were lower than that before perfusion,and the difference was statistically significant (P<0.05).CEA of 30 and 50 mg groups were (31.82±8.67) and (19.66±6.15) mg/ml after perfusion,which were lower than that before perfusion,and the difference was statistically significant (P<0.05).The cerebrospinal fluid cytology (+) rate in 50 mg group was 17.6%(3/17),which was lower than 17.6%(3/17) before perfusion,and the difference was statistically significant (P<0.05).There was no significant difference in the positive rate of nerve root reaction among the four groups after perfusion (P>0.05).WBC and PLT of 50 mg group were (4.8±1.3)×10^(9)/L and (141.3±17.6)×10^(9)/L after perfusion,which were lower than that before perfusion,and the differences were statistically significant (P<0.05).Conclusion Intrathecal infusion of 50 mg pemetrexed can significantly eliminate cancer cells and rapidly alleviate symptoms,with con

关 键 词：培美曲塞 鞘内灌注 肺癌 脑膜转移 

分 类 号：R734.2[医药卫生—肿瘤]