左旋精氨酸预防大剂量顺铂急性肾毒性的剂量探讨

目的探讨左旋精氨酸预防大剂量顺铂急性肾毒性的最佳剂量。方法选择128例肿瘤病人,随机分为A、B、C3组,3组病人顺铂的剂量及用法相同,均为100mg/m2,分两天(第1、2天)给药。3组病人左旋精氨酸的用量分别为每天5g/m2、10g/m2和15g/m2,于化疗的当天在顺铂后应用,每例病人加与不加精氨酸周期的两周期化疗形成自身对照,每例病人化疗前及化疗后24h均检测尿β2-MG、血尿素氮(BUN)、血肌酐(Cr)及血尿酸,观察3组病人加与不加精氨酸周期化疗前后各观察指标的变化,并比较3组的疗效。结果血BUN、Cr及尿酸无论在加精氨酸周期还是在不加精氨酸周期,化疗前后检测值均无明显变化,该3项指标不宜作为早期急性肾功能损害的检测指标。而A、B、C3组病人化疗后的尿β2-MG值在加与不加精氨酸周期分别为0.9120±0.6618与1.5167±0.7908(P<0.05)、0.5404±0.5810与1.4616±0.8120(P<0.01)及0.4998±0.6210与1.5210±0.7710(P<0.01),均有明显差别,B组的结果差别极其显著,C组的结果差别也极其显著。A、B、C3组的显效率及总有效率分别为40.9%及59.1%、68.2%及90.9%、77.5%及97.5%,经X2检验,A、B两组的显效率及总有效率均差别显著,B、C两组的显效率及总有效率均无显著性差别。结论左旋精氨酸有效预防大剂量顺铂急性肾毒性的最佳剂量为每天10g/m2,增加剂量并不增加疗效。

Dosage of L-arginine Preventing Acute High-dose PDDNephrotoxicity

Objective: To explore the optimal dose of L-arginine to prevent acute high-dose (HD)-PDD nephrotoxicity. Methods: 128 cases using PDD with the dosage of 100 mg/m² within two days (D1, 2) in combination with L-arginine were randomly divided into 3 groups of A, B and C. The dosages of Larginine in the 3 groups were 5 g/(m²·d), 10 g/(m²·d) and 15 g/(m²·d), respectively. Each patient received 2 cycles chemotherapy to form self control: 1 cycle combined with L-arginine, while 1 cycle chemotherapy alone. ß2-MG in urine, BUN, Cr and uric acid in blood were detected just 24 h before and after using PDD. The changes of each index in the three groups were observed in the presence or absence, and the therapeutic effects were compared among the three groups. Results: There was no significant difference in BUN, Cr and uric acid in blood before and after chemotherapy in the presence or absence, showing these indexes could not be used as markers of early acute nephrotoxicity. Urine ß2-MG values in the presence and absence were 0.9120±0.6618 vs 1.5167±0.7908 (P<0.05), 0.5404±0.5810 vs 1.4616±0.8120 (P<0.01), 0.4998±0.6210 vs 1.5210±0.7710 (P<0.01) in the groups A, B and C respectively. The excellent effective rate and total effective rate in groups A, B and C were 40.9% and 59.1%, 68.2% and 90.9%, and 77.5% and 97.5%, respectively. There was significant difference in the excellent effective rate and total effective rate between groups A and B, but not between groups B and C. Conclusion: The optimal dose of Larginine to prevent acute HD-PDD nephrotoxicity is 10 g/(m²·d). Increased dosage can't improve the effect accordingly.