目的 观察晚期非小细胞肺癌(NSCLC)中人类平衡型核苷转运蛋白1(hENT1)高表达患者应用不同剂量吉西他滨治疗的临床效果.方法 选取2008年7月至2013年12月于浙江金华广福医院行晚期NSCLC手术后,病理确诊晚期NSCLC患者,采用免疫组织化学SP法检测肺癌组织中hENT1抗体的表达水平.62例hENT1高表达患者入组,按随机数字表分组法分为对照组(30例)和观察组(32例).对照组采用常规剂量吉西他滨(1 000 mg/m2)联合顺铂进行化疗,观察组用低剂量吉西他滨(250 mg/m2)联合顺铂进行化疗,观察2组近期疗效、化疗不良反应.采用生活质量调查核心量表QLQ-C30和肺癌专用量表QLQ-LCl3比较2组化疗后生活质量.结果 对照组和观察组近期有效率和疾病控制率差异无统计学意义[43.3％ (13/30)比46.9％ (15/32),76.9％ (23/30)比81.2％(26/32)](x2 =0.08,x2 =0.20,P＞0.05).观察组Ⅲ、Ⅳ度白细胞减少、血小板减少及恶心、呕吐发生率低于对照组,差异有统计学意义(P＜0.05);除角色功能外,观察组化疗后总体生活评分及躯体功能、情绪功能、认知功能、社会功能、经济状况各项评分均优于对照组[(54±20)分比(54±16)分,(72±25)分比(62 ±20)分、(85 ±20)比(72±19)分、(76±28)分比(62±25)分、(61 ±24)分比(49 ±30)分、(36±24)分比(56±21)分],差异均有统计学意义(均P＜0.05).观察组除乏力症状外其他症状评分均优于对照组(P＜0.05).结论 对于晚期NSCLC术后hENT1高表达患者,在保证化疗效果的同时,相对于常规剂量吉西他滨,低剂量用药可有效降低化疗过程中不良反应,提高患者的生活质量.%Objective To observe the clinical effect of different doses of gemcitabine chemotherapy for patients with high expression of human equilibrative nucleoside transporter 1 (hENT1) after advanced non-smallcell lung cancer(NSCLC) operation.Methods Advanced NSCLC patients were selected in our hospital from July 2008 to December 2013,and advanced NSCLC with pathological diagnosis after operation,making the tumor tissue into paraffin block specimens,testing the expression level of hENT1 antibody by immunohistochemical SP method.62 cases with high expression of hENT1 were divided into two groups by the completely random digit grouping method,the control group were given chemotherapy with routine dose of gemcitabine combined with cisplatin,the observation group were given chemotherapy with low dose gemcitabine combined with cisplatin,the quality of life,curative effect and toxic and side reaction were observed in the two groups after chemotherapy.Results The shortterm effective rate and the disease control rate had no significant differences between the observation group and the control group[46.9％ (15/32) vs 43.3％ (13/30),81.2％ (26/32) vs 76.9％ (23/30)] (x2 =0.08,x2 =0.20,all P ＞ 0.05) ; the Ⅲ,Ⅳ side effects were compared between two groups after chemotherapy,the observation group was better than the control group in leukopenia,thrombocytopenia,nausea,vomiting,and there is a statistically significant difference(P ＜0.05) ; the quality life was compared between two groups after chemotherapy with quality of life questionnaire core scale QLQ-C30 and lung cancer specific scale QLQ-LC13.Except role function,the total score of quality of life,physical function,emotional function,cognitive function,social function and economic conditions in the observation group were better than those in the control group [(54 ± 20)scores vs (54 ± 16) scores,(72 ± 25) scores vs (62 ± 20) scores,(85 ± 20) scores vs (72 ± 19) scores,(76 ± 28) scores vs (62 ± 25) scores,(61 ± 24) scores vs (49 ± 30) scores,(36 ± 24) scores vs (56 ± 21) scores],the difference was statistically significant(P ＜ 0.05).The other symptom scores of observation group were better than the control group except fatigue (P ＜ 0.05).Conclusion While maintaining the equal chemotherapy effect compared with routine dose of gemcitabine and for patients with high expression of hENT1 after advanced NSCLC operation,using low dose gemcitabine can effectively reduce the toxic side reaction and improve the patients' quality life in chemotherapy process.
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