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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。
Objective To investigate the best dosage of L-arginine for preventing acute nephrotoxicity of large-dose cisplatin. Methods A total of 128 patients with tumor were randomly divided into A, B and C3 groups. The dose and usage of Cisplatin in the three groups were the same, all at 100 mg / m2, administered on two days (days 1 and 2). L-arginine levels in the 3 groups were 5 g / m2, 10 g / m2 and 15 g / m2 daily, respectively, after cisplatin administration on the day of chemotherapy, with each patient being treated with two cycles of chemotherapy without arginine cycle Before and after chemotherapy, the urinary β2-MG, blood urea nitrogen (BUN), serum creatinine (Cr) and serum uric acid were measured before and after chemotherapy in each patient. The changes of urinary β2-MG, Observed changes in the indicators, and compared the efficacy of the three groups. Results Blood BUN, Cr and uric acid showed no significant changes before and after chemotherapy, no matter arginine cycle or no arginine cycle. These three indexes should not be used as an indicator of early acute renal impairment. The urine β2-MG values of patients in groups A, B and C3 after chemotherapy were 0.9120 ± 0.6618 and 1.5167 ± 0.7908 (P <0.05), 0.5404 ± 0.5810 and 1.4616 ± 0.8120 (P < 0.01), 0.4998 ± 0.6210 and 1.5210 ± 0.7710 (P <0.01). There was a significant difference between the two groups. The difference between the two groups was extremely significant. The difference between the two groups was also significant. The effective rate and total effective rate of A, B and C3 groups were 40.9% and 59.1%, 68.2% and 90.9%, 77.5% and 97.5% respectively. The significant difference between the two groups was significant The difference was significant. There was no significant difference between the effective rate and the total effective rate in B and C groups. Conclusion The best dose of L-arginine for the prevention of acute nephrotoxicity of large doses of cisplatin is 10g / m2 per day. Increasing dosage does not increase the curative effect.