【作者】 刘俊玲； 吴海鹰； 戴文清； 黄岩； 黄蕾； 段海波；

【Author】 Liu Jun-Ling Wu Hai-Ying Dai Wen-Qing Huang Yan Huang Lei Duan Hai-Bo Department of Medical Oncology, Tumor Hospital of Sun-Yat-sen University, Guangzhou, Guangdong 510060, P.R.China

【机构】 中山大学附属肿瘤医院内科；

【摘要】 目的:观察晚期实体瘤合并糖尿病病人用含紫杉类药物方案化疗期间的血糖变化,探讨化疗期间血糖控制的特殊性及个体化治疗。方法:2003—2006年间我们收治入院的 20例化疗前确诊合并糖尿病的晚期实体瘤病人,化疗方案均包括紫杉类药物,需用地塞米松做预处理,血糖控制方法分别采用饮食运动,口服降糖药和皮下或静脉注射胰岛素。结果:发现本组病例按需要共化疗77程,化疗中位疗程数 4(2—7),使用地塞米松后血糖均有所升高,采用皮下注射胰岛素6例,胰岛素加用增敏药物1例,静脉滴注胰岛素 1例,口服降糖药9例,其中联用2种药物3例,1种药物6 例,靠饮食控制3例。由于合理的营养支持治疗及对血糖的有效干预,无1例患者出现糖尿病并发症而终止化疗或死亡。可评价疗效19例,乳腺癌3例PR,非小细胞肺癌12例, PR 8例SD 3例,PD1例。小细胞肺癌4例,CR 1例,PR3 例。化疗期间Ⅲ度以上胃肠道反应5／77(6．5％),Ⅲ度以上粒细胞减少伴发热仅6／77(7．8％),Ⅲ度以上PLT下降仅1／ 77(1．3％)。其它不良反应主要以头晕,脱发,肌肉酸痛, 肢端麻木较常见。结论:晚期实体瘤合并糖尿病病人用含紫杉类方案化疗期间血糖升高后,可根据糖尿病病情程度及血糖波动情况进行个体化控制,注射短效胰岛素是否更加合理且安全有效有待进一步研究。更多还原

【Abstract】 Objective: To observe changes of levels of serum glucose in advanced solid tumor with diabetes treated with taxanes-containing chemotherapy and furtherly discuss the specificity of serum glucose control and corresponding individualized management Methods: 20 patients diagnosed as advanced solid tumor with diabetes prior to the administration of taxanes-containing chemotherapy were admitted from 2003 to 2006. Due to dexamethasone used as one of the pre-disposal treatments, serum glucose control were necessarily adopted as dietary ,oral antidiabetic drugs and insulin either by the route of subcutaneous or that of intravenous injection, respectively. Results: 77 cycles in this group were carried out, which the number of median cycles were 4 (2 to 7cycles for each patient). The arising of the level of serum glucose after the administration of dexamethesone was observed and insulin by the route of subcutaneous injection or by that plus sensitization drug or by the route of intravenous injection were administered to 6 patients, 1 patient, 1 patient, respectively. Oral antidiabetic drugs were administered to 9 patients, which 2 different drugs were taken concurrently by 3 of them and only one drug by 6 of them. Alimentary control was adopted by 3 patients. Due to the reasonable nutritional support and effective intervention, no acute diabetic complication was emerged in this group patients which lead to the termination of chemotherapy or the death event Response rate could be evaluated in 19 cases. Specific evaluation of response was demonstrated PR for 3 patients with breast cancer, PR for 8 patients and SD for 3 patients and PD for 1 patient with non-small cell lung cancer, CR for 1 patient and PR for 3 patients with small cell lung cancer. Grade 3 and 4 toxicities were as following : gastrointestinal tract toxicity 5/77 (6.5%) , granulocytopenia accompanied by fever 6/77 (7.8%) , thrombocytopenia 1/77 (1.3%). Other common adverse effects were dizziness, alopecia, myalgias, acroanesthesia. Conclution The arising of the level of serum glucose by taxane-containing chemotherapy in advanced solid tumor with diabetes could be controlled by individual management according to the degree of the fluctuation of serum glucose and pathogenetic condition of diabetes. Whether insulin by the route of both subcutaneous and intravenous injection is more reasonable, safe and effective need further study.更多还原