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目的研究预防性糖皮质激素的使用对实体瘤患者化疗后粒细胞减少的影响及机制。方法按照使用糖皮质激素与否,将39例患者分为激素组(20例)和非激素组(19例),采用Annexin-Ⅴ/PI方法检测化疗前(第1天)、化疗后(第6天)外周血粒细胞凋亡,同时检测粒细胞表面Fas的表达,并观察它们与粒细胞数目变化的关系。结果 (1)激素组化疗后粒细胞Fas表达高于化疗前(P<0.05),粒细胞计数、凋亡率差异前后未见统计学意义;非激素组化疗后粒细胞计数低于化疗前,凋亡率、Fas表达均高于化疗前,差异可见显著性差异(P<0.05)。(2)化疗前中性粒细胞计数与凋亡率负相关(r=-0.370,P=0.020);非激素组化疗后中性粒细胞凋亡率与Fas表达正相关(r=0.518,P=0.023)。(3)激素组、非激素组第6天粒细胞下降的患者分别为45%(9/20)、89.5%(17/19);而第8天粒细胞下降的患者分别为50%(10/20)、100%(19/19);激素组粒细胞下降的患者比例均低于非激素组(P<0.05)。结论糖皮质激素可以影响化疗药物对中性粒细胞的凋亡诱导作用,抑制中性粒细胞减少的发生,这个作用可能不全是通过Fas途径诱导凋亡导致的。临床上使用糖皮质激素的化疗患者粒细胞减少的规律不同于未用激素者。
Objective To study the effect and mechanism of prophylactic glucocorticoid therapy on neutropenia in patients with solid tumors after chemotherapy. Methods 39 patients were divided into hormone group (n = 20) and non-hormone group (n = 19) according to whether glucocorticoids were used or not. Before and after chemotherapy (day 1), Annexin- 6 days) peripheral blood neutrophil apoptosis, and detect the expression of Fas on the surface of granulocytes, and observe their relationship with changes in the number of granulocytes. Results (1) The expression of Fas in granulocyte in the hormone group was higher than that before chemotherapy (P <0.05), and there was no statistical significance in the difference of the granulocyte count and the apoptosis rate before and after the chemotherapy. In the non-hormone group, the granulocyte count was lower than before chemotherapy, The apoptotic rate and Fas expression were significantly higher than those before chemotherapy (P <0.05). (2) The neutrophil count was negatively correlated with the apoptosis rate before chemotherapy (r = -0.370, P = 0.020). The apoptosis rate of neutrophils in the non-hormone group was positively correlated with the Fas expression (r = 0.518, P = 0.023). (3) 45% (9/20) and 89.5% (17/19) patients in the hormone group and the non-hormone group on the 6th day, respectively. The number of neutrophils on the 6th day was 50% (10 / 20) and 100% (19/19) respectively. The proportion of patients with decreased neutrophil in the hormone group was lower than that in the non-hormone group (P <0.05). Conclusion Glucocorticoid can affect the induction of neutrophil apoptosis by chemotherapeutic drugs and inhibit the neutropenia. This effect may be caused by the apoptosis induced by Fas pathway. The clinical use of glucocorticoid chemotherapy in patients with neutropenia is different from those without hormones.