FOLFIRI方案化疗对肾上腺皮质激素动态影响.docVIP

FOLFIRI方案化疗对肾上腺皮质激素动态影响 　 作者：汤菊萍 姜怡乾 李朝阳 陈灵芝 宫赟正 【摘要】 [目的]探讨FOLFIRI方案化疗对肾上腺皮质激素的动态影响。[方法]选择胃肠癌根治术后男性患者共41例，分为化疗组21例和对照组20例，分别于FOLFIRI化疗开始前(化疗开始0月)和结束时(化疗开始6月)，化疗结束后6月和FOLFIRI化疗结束后1年时(化疗开始18个月)监测患者血浆皮质醇和醛固酮水平。[结果]在18个月的观察期内对照组的糖皮质激素无明显变化;醛固酮的活性水平呈升高趋势，化疗组的糖皮质激素活性水平在化疗后明显升高，超过正常水平，化疗结束6个月后仍高于化疗前和对照组同期水平，化疗结束12个月后才降至正常，醛固酮在6个疗程的FOLFIRI方案化疗后呈明显降低，而化疗结束12个月后仍未完全恢复。[结论]FOLFIRI方案对分泌糖皮质激素的内分泌细胞无明显器质性损伤，但可能永久性地损害了交感神经兴奋性或/和相应的内分泌细胞，造成醛固酮分泌障碍。 【关键词】 FOLFIRI方案;皮质醇;醛固酮;胃肠癌根治术 　　Abstract： [Objective]To explore the dynamic influence of chemical therapy PLOFIRI plan on adrenal cortex hormones.[Method]Select 41 male cases with gastricintestinal cancer halsted operation, divide them into chemical therapy group(1) with 21 cases and control one 20(2), respectively measure both cortisol and aldosterone levels at 6m and 1 year after FOLFIRI therapy.[Result]After chemical treatment for 18m, in group 2, there?s no marked change on glucocorticoid, the aldosterone was raised; in group 1, the glucocorticoid was much more increased than normal level, even 6m after the end of treatment, still higher than that before treatment and that of control one of the same period, but decreased to normal after 12m; while the aldosterone was markedly decreased after 6 courses of the plan and could not recover after 12m.[Conclusion]FOLFIRI plan has no marked organic injury incretion cell for glucocorticoid, but may permanently injure the corresponding incretion cells or sympathetic excitatory, causing disordered secretion of aldosterone. 　　Key words： PLOFIRI plan; cortisol; aldosterone;gastricintestinal cancer halsted operation 　　 FOLFIRI(亚叶酸+5氟尿嘧啶+伊利替康)方案对多种恶性肿瘤有效，是目前最常用的联合化疗方案之一。FOLFIRI化疗现已成为肠癌术后化疗的一线方案和晚期姑息治疗的重要手段。但是，FOLFIRI方案因多药联合化疗,各药毒性互相加重而毒副反应较大，特别是多周期用药后常出现剂量累积性的神经内分泌毒性[1]，影响患者生理功能及治疗计划的完成。 　　1 资料与方法 　　1.1 一般资料 2006年6月至2008年10月我院收治的住院胃肠癌根治术后男性患者共41例，年龄50～70岁，平均(58.51±4.76)岁。入选标准：全部患者诊断均为病理证实并除外其它肿瘤、垂体和肾上腺疾病史。随机分为化疗组21例和对照组20例，组间年龄构成相当。各组并无其它对垂体、肾上腺可能有明显影响的辅助用药和长期应用类固醇激素。FOLFIRI方案化疗(亚叶酸和伊利替康为江苏恒瑞