不同化疗方案对肺癌合并慢性肾衰竭患者肾功能的影响

摘要

Objective To investigate the effect of different chemotherapy ( TC,DC,GC,PC) on the renal function of the lung cancer patients combined with chronic renal failure ( compensated stage ) .Methods Sixty seven cases of non -small cell lung cancer patients were selected for their first chemotherapy treatment , all of whom combined with the chronic renal failure ( compensated stage ) before chem-otherapy.Their age ranged from 41 to 70.According to the chemotherapy scheme , they were dirided into four groups:(1)TC group:taxol 135 mg/m2 , d1+carboplatin AUC 5, d1, 21 days repeat;(2) DC group:docetaxel 75 mg/m2 , d1+carboplatin AUC 5, d1, 21 days re-peat;(3) GC group:gemcitabine 1000 mg/m2 , d1,8+carboplatin AUC 5,d1, 21 days repeat;(4) PC group (limited to non-squamous carcinoma):pemetrexed 500mg/m2 , d1+carboplatin AUC 5, d1, 21 days repeat.The glomerular filtration rate which representing the renal function was detected before as well as after the second cycles of chemotherapy , compared the change of renal function in patients in-volved different chemotherapy scheme .Results Before the treatment , the glomerular filtration rate of four groups were: TC group (77.1 ±16.41)ml/min, DC group (71.82 ±12.41)ml/min, GC group (74.86 ±10.42)ml/min, PC group (59.45 ±9.07)ml/min;after the second cycle chemotherapy , the glomerular filtration rate respectively were (69.76 ±8.89)ml/min(TC group), (66.21 ±13.5) ml/min(DC group), (70.71 ±9.4)ml/min(GC group),(61.75 ±10.77)ml/min(PC group).The glomerular filtration rate of TC group decreased by (7.33 ±2.46)ml/min after chemotherapy,as well as the glomerular filtration rate of DC group decreased by (7.33 ± 2.46)ml/min, and both of them were statistically significant (P<0.05).The glomerular filtration rate changed in GC group and PC group had no statistical significance (P>0.05).The glomerular filtration rate of TC group decreased more than that of DC group , and the difference was statistically significant (P<0.05).Conclusion For non-small cell lung cancer patients who complicated with chronic renal failure(compensated stage), the use of GC, PC scheme has no significant adverse effect on their renal function , but TC, DC schememay cause decline in renal function .The declining degree of TC scheme is higher than that of DC scheme .%目的 观察TC、DC、GC、PC 4种化疗方案对非小细胞肺癌合并慢性肾衰竭(代偿期)患者肾功能的影响. 方法选择67例首次化疗的非小细胞肺癌患者,化疗前处于慢性肾衰竭(代偿期) ,患者年龄41~70岁,按所接受的方案分为4组:①TC组:紫杉醇135mg/m2 ,d1+卡铂AUC 5,d1,21天重复;②DC组:多西他赛75mg/m2 ,d1+卡铂AUC 5,d1,21天重复;③GC组:吉西他滨1000mg/m2 ,d1,8+卡铂 AUC 5,d1,21天重复;④PC组(只限于非鳞癌患者):培美曲塞500mg/m2 ,d1+卡铂 AUC 5, d1 ,21天重复;以肾小球滤过率代表其肾功能,检测化疗前及2程化疗后肾小球滤过率,比较不同化疗方案前后患者肾功能的变化. 结果 治疗前,4组患者肾小球滤过率为TC组77.1 ±16.41ml/min,DC组71.82 ±12.41ml/min,GC组74.86 ±10.42ml/min,PC组59.45 ±9.07ml/min;2程化疗后肾小球滤过率为TC组69.76 ±8.89ml/min,DC组66.21 ±13.5ml/min,GC组70.71 ± 9.4ml/min,PC组61.75 ±10.77ml/min. TC组化疗后肾小球滤过率较前下降7.33 ±2.46ml/min,DC组化疗后肾小球滤过率较前下降5.61 ±2.63ml/min,差异均有统计学意义(P<0.05);GC组及PC组化疗前后肾小球滤过率改变差异无统计学意义(P>0.05);TC组化疗后肾小球滤过率下降程度高于DC组,差异有统计学意义(P<0.05). 结论 对于非小细胞肺癌合并慢性肾衰竭(代偿期)患者,使用GC、PC方案化疗对肾功能无明显不良影响,而TC、DC方案可能引起肾功能下降,其中TC方案引起的肾功能不良反应程度高于DC方案.