2015 年第 4 期 第 13 卷

在尿苷二磷酸葡萄糖醛酸转移酶1A1*28野生型TA6/6患者中伊立替康联合顺铂或氟尿嘧啶不良反应的比较

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关键词：伊立替康顺铂氟尿嘧啶不良反应

• 摘要：
• 【摘要】目的：比较尿苷二磷酸葡萄糖醛酸转移酶1A1（UGT1A1）*28启动子为野生型TA6/6患者在使用伊立替康联合顺铂（IP）或伊立替康联合氟尿嘧啶/亚叶酸钙（FOLFIRI）不良反应方面差异。方法：对使用含伊立替康方案化疗患者进行UGT1A1*28启动子多态性检测，对UGT1A1*28野生型TA6/6的患者按治疗要求分成IP组和FOLFIRI组，比较不良反应差异。结果：IP组47例，FOLFIRI组51例。在总体3、4度不良反应方面，IP组明显高于FOLFIRI组（61.7%VS39.2%，P=0.026）。血液学毒性方面，IP组3、4度WBC减少、NEUT减少、PLT减少和HGB减少发生率分别为34.0%、51.1%、14.9%和8.5%，FOLFIRI组发生率分别为11.8%、29.4%、2.0%、0%，组间有统计学差异，P值均<0.05；在非血液学方面，FOLFIRI组3度及以上迟发性腹泻发生率9.8%，IP组未发生3、4度腹泻，两组间有统计学差异（P=0.028）。结论 UGT1A1 *28野生型TA6/6患者在伊立替康联合顺铂和伊立替康联合氟尿嘧啶/亚叶酸钙两种化疗方案不良反应谱存在差异，IP组3-4度WBC减少、HGB减少、PLT减少更常见，FOLFIRI组3度及以上腹泻发生率更高。
• Background: The genotype of uridine diphosphate glucuronosultransferase 1A1(UGT1A1) is associated with the toxicity of irnotecan, but the different toxicity of irinotecan combined with cisplatin(IP) or flrorouracil/leucovorin(FOLFIRI) in patient UGT1A1 *28 wild genotype（TA6/6）is unknown. Method: Genomic DNA was extracted from peripheral blood to identify the UGT1A1*28 wild genotype （TA6/6） in patients treated with irinotecan-contained chemotherapy. The study compared IP (n=47) and FOLFIRI (n=51) in patients with UGT1A1*28 wild genotype TA6/6. ?2 were used to investigate the difference of toxicity between patients with IP and FOLFIRI. Result: The incidence of overall grade 3 or 4 toxicity was higher with IP than with FOLFIRI（61.7% vs. 39.2%;HR=1.57, 95%CI 1.045-2.369; P=0.026）. Serious hematological toxicity was higher in the IP group versus the IF group for grade 3/4 neutropenia（51.1% vs. 29.4%, P=0.029）,grade 3/4 anemia（8.5% VS 0%，P=0.033） and grade 3/4 thrombocytopenia （14.9% vs. 1.9%, P=0.019）. However, serious diarrhea was more common in FOLFIRI group than IP group.（9.8% vs. 0%, P=0.028）. Conclusion: The adverse events were different in patients treated by IP or FOLFIRI with UGT1A1 *28 wild genotype （TA6/6）. With the IP group, serious hematological toxicity was higher, while diarrhea occurred significantly more often in the FOLFIRI group.