| 刘思旋,李晓林,陈 璇,马丽思,翁怀玉,宗祥云.环磷酰胺辅助化疗对不同年龄乳腺癌患者卵巢功能的损伤情况及机制研究[J].,2021,(5):850-856 |
| 环磷酰胺辅助化疗对不同年龄乳腺癌患者卵巢功能的损伤情况及机制研究 |
| Study on the Damage and Mechanism of Cyclophosphamide-assisted Chemotherapy on Ovarian Function in Patients with Breast Cancer at Different Ages |
| 投稿时间：2020-07-23 修订日期：2020-08-18 |
| DOI：10.13241/j.cnki.pmb.2021.05.010 |
| 中文关键词: 环磷酰胺 卵巢损伤 抗缪勒氏管激素 |
| 英文关键词: Cyclophosphamide Ovarian damage Anti-Müllerian hormone (AMH) |
| 基金项目:上海市科学技术委员会西医引导项目（15411966500） |
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| 中文摘要: |
| 摘要 目的：以月经变化情况及血清激素水平为观察指标，探讨环磷酰胺辅助化疗方案对绝经前不同年龄段乳腺癌患者卵巢功能的损伤情况及可能的机制研究。方法：收集2017年1月至2018年12月期间在我院接受环磷酰胺辅助化疗的绝经前乳腺癌患者77例。患者年龄范围为26-48岁，并按年龄分为两组：≤35岁组为16例； >35岁组为61例。调查研究两组患者化疗前后的月经情况，以及血清激素水平（E、FSH、AMH）。同时进行动物实验，采用单剂量环磷酰胺（200 mg/kg）处理不同月龄组（3月龄和6月龄）雌性C57BL/6J小鼠，每组小鼠12例。在环磷酰胺处理前及处理后一周，检测小鼠血清AMH水平，计数小鼠卵巢卵泡数量。结果：环磷酰胺化疗后，>35岁组与≤35岁组间比较，>35岁组闭经率更高，复经率更低，血清AMH和E2水平下降幅度更大（P<0.05），FSH水平升高幅度也大于≤35岁组，但差异无明显统计学意义（P>0.05）。不同年龄组内比较，≤35岁组患者化疗后的血清AMH和E2下降水平无明显差异（P>0.05）；血清FSH水平明显升高（P<0.05）。而>35岁组的患者化疗后，血清AMH和E2水平明显下降，FSH水平明显升高，差异均有统计学意义（P<0.05）。不同月龄组小鼠环磷酰胺处理前后，血清AMH水平明显下降，卵巢原始卵泡和生长卵泡数明显较少，差异均有统计学意义（P<0.05），且6月龄组小鼠下降程度更明显（P<0.05）。结论：环磷酰胺辅助化疗方案明显损伤患者卵巢功能，且对年龄越大者损伤程度越严重，更易导致不可逆性卵巢损伤。 |
| 英文摘要: |
| ABSTRACT Objective: To study the damage of cyclophosphamide adjuvant chemotherapy on ovarian function in different age groups of premenopausal breast cancer patients and the possible mechanism, the changes of menstruation and serum hormone level were observed. Methods: 77 premenopausal breast cancer patients who received cyclophosphamide adjuvant chemotherapy in our hospital from January 2017 to December 2018 were collected. The age range of the patients was 26-48 years old, and they were divided into two groups by age: 16 cases in the group of ≤ 35 years old and 61 cases in the group of > 35 years old. To investigate the menstruation and serum hormone levels (E, FSH, AMH) of the two groups before and after chemotherapy. At the same time, a single dose of cyclophosphamide (200 mg/kg) was used to treat female C57BL / 6J mice of different age groups (3 and 6 months), 12 mice in each group. Before and one week after cyclophosphamide treatment, the serum AMH level and the number of ovarian follicles were measured. Results: After cyclophosphamide adjuvant chemotherapy, the >35-year-old group had a higher amenorrhea rate and lower menstrual recovery rate than the ≤35-year-old group. The levels of serum AMH and E2 decreased more significantly (P<0.05), and the increase of FSH levels was greater than ≤35 year-old-group, but the difference was not statistically significant (P>0.05). Comparing within different age groups, there was no significant difference in the levels of serum AMH and E2 after chemotherapy in patients ≤35 years old (P> 0.05); but the levels of serum FSH significantly increased after chemotherapy (P<0.05). In > 35-year-old group, serum levels of AMH and E2 decreased significantly, and FSH levels increased significantly after chemotherapy. The differences were statistically significant (P<0.05). Before and after cyclophosphamide treatment in mice of different month-old groups, serum AMH levels decreased significantly, and the number of ovarian primordial follicles and growing follicles was significantly less. The differences were statistically significant (P<0.05), and the decrease was more significant in the 6-month-old group (P<0.05). Conclusion: Cyclophosphamide adjuvant chemotherapy significantly damages the ovarian function of patients, and the older the patients are, the more serious the damage is, the more likely to lead to irreversible ovarian damage. |
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