摘要
目的研究不同化学治疗方案对乳腺癌患者认知功能的影响,以及炎性细胞因子水平变化与患者认知功能变化之间的相关性。方法选取87例接受术后EC-T方案(表柔比星、环磷酰胺序贯多西他赛,28例)、FEC方案(表柔比星、氟尿嘧啶、环磷酰胺,31例)和TC方案(多西他赛、环磷酰胺,28例)化学治疗的早期乳腺癌患者,EC-T方案8个疗程、FEC方案6个疗程、TC方案4个疗程,每个疗程均为21d。患者在化学治疗开始前3d(治疗前)、全部疗程结束后3d(治疗后)分别应用简易精神状态量表(MMSE)和中文听觉词语学习测验(AVLT)进行认知功能检查,同时检测血浆炎性细胞因子IL-1、IL-6、TNF-α水平。结果接受EC-T方案治疗的患者治疗后血浆IL-1和IL-6水平升高幅度显著大于其他两种治疗方案(P值均<0.01),接受TC方案治疗的患者治疗后血浆IL-1和TNF-α水平升高幅度均显著小于其他两种治疗方案(P值均<0.01)。接受EC-T方案治疗的患者治疗后MMSE评分和AVLT平均得分的降低幅度均显著大于其他两种治疗方案(P值均<0.01)。患者治疗前后血浆IL-1和TNF-α水平变化与AVLT平均得分变化呈负相关(相关系数分别为-0.581和-0.303,P值均<0.01),治疗前后血浆IL-6水平变化与AVLT平均得分变化不相关(P=0.07)。结论乳腺癌患者术后接受化学治疗后血浆炎性细胞因子IL-1、IL-6和TNF-α水平较化学治疗前出现不同程度升高,认知功能出现下降。相比于FEC方案和TC方案,EC-T方案治疗后IL-1、IL-6、TNF-α水平升高最为明显,MMSE评分和AVTL平均得分降低最多。治疗前后血浆IL-1和TNF-α水平变化与AVLT平均得分变化呈负相关。
Objective To study the changes of inflammatory factors and cognitive function in patients with breast cancer before and after different chemotherapy regimens, and to explore the correlation between them. Methods A total of 87 early-stage breast cancer patients who underwent adjuvant chemotherapy after operation were enrolled in this study. Of them, 28 were treated with regimen of EC-T （epirubicin/cyclophosphamide followed by docetaxel） for 8 cycles, 31 with FEC （fluorouracil/epirubicin/cyclophosphamide） for 6 cycles, and 28 with TC （docetaxel/cyclophosphamide） for 4 cycles. There were 21 days in each cycle. Mini mental state examination （MMSE） and auditory verbal learning test （AVLT） were used to measure cognitive function before and 3 days after chemotherapy. Meanwhile, peripheral blood samples were assayed for inflammatory factors, such as interleukin-1 （IL-1）, interleukin -6 （IL-6） and tumor necrosis factor-a （TNF-a）. Results The up-regulation of IL-1 and IL-6 in the EC-T group was significantly higher than those in the other groups （all P〈0.01） after the chemotherapy. The least up-regulation of IL-1 and TNF-α was found in the TO group （all P〈0.01）. The greatest decline in MMSE and AVLT scores appeared in the EC-T group （all P〈0.01）. The plasma levels of IL-1 and TNF-α were negatively correlated with AVLT cognitive scores （coefficient correlation was -0. 581 and -0. 303, respectively, both P〈 0.01）, but there was no relationship between the IL-6 and AVLT score （P = 0.07）. Conclusion The levels of IL-1, IL-6 and TNF-α increase in plasma of patients with breast cancer after chemotherapy, while the cognitive function declines. Compared to FEC and TO groups, the EC-T group has the most significant up-regulation in the plasma levels of IL-1, IL-6 and TNF-α after chemotherapy and the greatest decline in MMsE and AVLT scores. The levels of IL-1 and TNF-α are negatively correlated with AVLT cognitive scores.
出处
《上海医学》
北大核心
2017年第9期548-551,共4页
Shanghai Medical Journal
基金
同济大学附属杨浦医院科研资助项目(Se201522)
