| BackgroundLung cancer(LC)is the malignant solid tumor disease with the highest morbidity and mortality in the world.The prevalence of lung cancer Increases year by year.With the development of science,there are more and more treatments for lung cancer patients.Systemic chemotherapy is still the main treatment for patients with advanced lung malignant tumors who have mutations in some genes,have no mutations and do not accept gene testing.Whether it is No-n-Small Cell Lung Cancer(NSCLC)or Small Cell Lung Cancer(SCLC),chemo-therapy drugs can cause different degrees of myelosuppression.These toxic drugs can induce apoptosis and depletion of hematopoietic stem cells(HSC)and hematopoietic progenitor cells(HPCs)and destroy the hematopoietic function of bone marrow.Because the half-life of neutrophils(ANC)is relatively short,when bone marrow hematopoiesis is inhibited,the absolute value of neutrophils decreases first,which can easily lead to adverse consequence s such as infection.When persistent ANC decline leads to neutropenia with febrile neutropenia(FN)and severe infection,treatment time may be delayed,curative effect may be reduced,re-hospitalization/hospitalization rate may be increased,and even death may occur.Therefore,how to effectively prevent neutropenia,reduce the incidence of FN,and assess the quality of life of patients become more important.Pegylated Recombinant Human Granulocyte Stimulating Factor(PEG-rhG-CSF)is considered tobe an effective drug for the prevention and treatment of neutropenia caused by tumor chemotherapy.When the risk of FN is higher than 20%,as a preventive improvement of granulocytopenia,compared with Recombinant Human Granulocyte Stimulating Factor(rhG-CSF),the safety and feasibility of its application have been Numerous clinical trials have confirmed,but there are often problems such as irregular medications and poor patient compliance in clinical applications,which deserves further study and standard application in clinical practice.PurposeThis article aims to investigate the efficacy of PEGylated recombinant human granulocyte stimulating factor and recombinant human granulocyte stimulating factor in preventing neutropenia after chemotherapy for lung malignant tumors,and to analyze the factors affecting the efficacy of chemotherapy and to evaluate pre-chemotherapy.Changes in the quality of life of patients after surgery provide a clinical reference for improving neutropenia after chemotherapy.MethodsCollect Liaoning Tumor Hospital between January 2017 and February 2019 in lung cancer patients,all patients by pathological diagnosis is clear,and after a line after che motherapy III/IV neutropenia.Conduct a retrospective analysis.After screening,a total of 77 eligible patients.According to the different medications,the experiment was divid ed into two groups: long-acting group,the short-acting group and the short-acting insuff icient group.Long-acting group: 27 cases of PEG-rhG-CSF group were used in PEGylat ed recombinant human granulocyte stimulating factor(PEG-rhG-CSF)group.whether t he prophylactic use of short-acting granulocyte stimulating factors is sufficient,the shor t-acting group and the short-acting insufficient group.Short-acting full-acting group: 18 patients Short-acting insufficient group: 32 cases After the end of chemotherapy,the lo ng-term group was given PEG-rhG-CSF 6mg(Weigh less than 45 kg,3mg)subcutaneou sly for the preventive treatment of neutropenia,which was injected once per chemothera py cycle.The short-acting group was given subcutaneous injection of rhG-CSF(5?g/kg/d)at 24-48 hours after the end of chemotherapy,whether the ANC recovered from thelowest point to normal or near normal(ANC rebounded to 2.0×109/L or more).Observa tion indexes: the change of neutrophil absolute value after chemotherapy in the two gro ups;the proportion of grade ? / ? neutropenia and the duration of neutropenia in the i nterval between chemotherapy in the two groups;the change of neutrophil after chemot herapy;and the incidence of neutropenia with fever and the rate of re-entry due to FN in the two groups,reactions and complications.To evaluate the quality of life of patients before and after chemotherapy.All the data were analyzed by spss22.0 statistical softwa re,the measurement data were expressed by mean ± standard deviation,the difference b etween the two groups was analyzed by independent sample t-test,the difference betwe en the two groups was analyzed by chi square test,and P < 0.05 was statistically signific ant.Then we searched Pub Med,EMBASE,China biomedical literature database,China Journal Full-text Database,VIP database and Wanfang database by computer(the retrie val time of each database was from the establishment to December 27,2019).We used Revman 5.3 software to conduct meta-analysis on the literatures that met our inclusion c riteria.ResultThe values of neutrophils,hemoglobin and platelets in the two groups w-ere in the normal range before chemotherapy.There was no statistical difference between the groups,which was comparable.1.Changes in neutrophils hemoglobin and platelets in two groups at different time points after chemotherapy:Neutrophils: the mean value of neutrophils in the long-term group was hi g-her than that in the short-term group 5-7 days and 14-18 days after chemotherapy,and there was a statistical difference between the two groups(P<0.05).2.Comparison of III/IV degree neutropenia after chemotherapy:Long-term group III/IV degrees lower incidence of neutropenia short-acting group,with statistical difference(long-term group vs.short-acting insufficient group = 18.5%vs.46%,P<0.01).The duration of neutropenia in the long-acting group was 2.53(±0.92)days,shorter than that in the short-acting group,but there was no significant difference between the two groups.3.Trends in neutrophil changes:There were different degrees of neutropenia after chemotherapy in the two groups:the absolute value of neutrophils in the long-acting group increased from the end of chemotherapy to 3 days after chemotherapy,and the mean value was slightly higher than the short-acting group.The neutrophils were minimized in the two groups on days5-7 after chemotherapy.The mean values of neutrophils in the two groups increased again on days 9-12,and the long-acting group did not decrease at 1 4-18 days after chemotherapy,while the short-acting group decreased again at 14-18 days after chemotherapy.During the chemotherapy interval,only one peak appeared in the longacting group,and the post-blood image became stable;while the short-acting group showed two peaks.4.The incidence of neutropenic fever(FN)and the re-entry of FN to hospital:In the two groups,a total of 16 patients developed neutropenic fever,and 16 patients returned to hospital again for antibiotic anti infection treatment,including 2 in the long-term group and 14 in the short-term group.The incidence of FN in the longterm group was significantly higher than that in the short-term group(long-term group vs.short-term group = 7.4% vs.22%,P < 0.05).There was also statistical difference between the two groups due to FN re-entry(long effect group vs.short effect group =7.4% vs.22%,P < 0.05).5.Adverse reaction analysis:The adverse reactions of the two groups were asthenia and pain at the injection site.There was no significant difference between the two groups(P > 0.05).6.Complications analysis:Mild bone pain is a common complication.There was no significant difference between the two groups(P > 0.05).7.Quality of life measurement before and after chemotherapy:There were statistically significant differences in physical function,role function,cognitive function,fatigue,pain,nausea and vomiting,shortness of breath,insomnia,loss of appetite,economy and overall quality of life between 77 patients before and after chemotherapy(P<0.05),and no statistically significant differences in emotional function,constipation and diarrhea(P>0.05).Comparison of overall scores: the overallfunctional status of 77 patients improved after chemotherapy;Fatigue,pain,shortness of breath and insomnia were better than before chemotherapy.Nausea,vomiting,loss of appetite,constipation and diarrhea were worse than before.Economic pressure increased after chemotherapy;The overall quality of life was significantly improved compared with that before chemotherapy.8.Subgroup analysis:According to whether the short effect group is sufficient,it is divided into short effect sufficient group and short effect insufficient group.It was found that there was no significant difference in the incidence of grade ? / ? neutropenia between the short effect sufficient group and the short effect insufficient group(P >On the ANC curve,there were two peaks in the short effect sufficient group and the short effect insufficient group.The mean value of neutrophils in the two groups increased 9-12 days after chemotherapy,but the mean value in the short effect sufficient group was significantly higher than that in the short effect insufficient group.There was statistical difference between the two groups(P < 0.05);the mean value decreased again 14-18 days after chemotherapy.The mean value of neutrophils in the long-acting group was higher than that in the short-acting group 5-7 days and 14-18 days after chemotherapy.There was a statistical difference between the two groups(P < 0.05).9.Meta analysis results show:A total of 8 RCT documents were included.CI [0.57,1.45],OR = 0.79 in the second period,95% CI [0.52,1.20],OR = 0.46 in the third period,95% CI [0.13,1.55],OR = 0.98,95% CI in the fourth period [ 0.57,1.68];the incidence of bone pain OR =0.81,95% CI [0.58,1.22];the total FN incidence and the incidence of bone pain have no statistical difference between the two groups;In the third chemotherapy cycle,the PEG-rhG-CSF group can reduce the incidence of FN compared with rhG-CSF,but the results of other cycles are not statistically different.Conclusion1.Compared with rhG-CSF,PEG-rhG-CSF can significantly reduce the incidence of III/IV neutropenia,the incidence of FN and the rate of re-entry.2.There is a certain trend in neutrophil changes after chemotherapy.3.The adverse reactions of PEG-rhG-CSF were similar to those of rhG-CSF.4.Meta data analysis showed that PEG-rhG-CSF and rhG-CSF were not statistically different from each other.After chemotherapy,the functional status is better than before,the tumor-related symptoms are less than before,the drug-related symptoms are aggravated,and the overall quality of life is improved compared with chemotherapy before treatment. |
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