中华物理医学与康复杂志
中華物理醫學與康複雜誌
중화물리의학여강복잡지
CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
2014年
9期
709-713
,共5页
钟国成%吴超群%陈青%冯怀志%匡红%李硕%桂永忠%孙薏
鐘國成%吳超群%陳青%馮懷誌%劻紅%李碩%桂永忠%孫薏
종국성%오초군%진청%풍부지%광홍%리석%계영충%손의
原发性肝癌%高强度聚焦超声%超声造影%肿瘤免疫
原髮性肝癌%高彊度聚焦超聲%超聲造影%腫瘤免疫
원발성간암%고강도취초초성%초성조영%종류면역
Hepatocellular carcinoma%Ultrasound%Ultrasonography%Tumors
目的 对高强度聚焦超声(HIFU)治疗原发性肝癌的免疫学效应以及影像学评估手段进行初步探讨.方法 选取63例接受HIFU治疗的肝癌患者作为病例组,另选39例健康志愿者作为对照组,记录63例患者在HIFU治疗前后的免疫学指标,并与健康对照组进行比较;病例组治疗后3个月,将临床疗效较好的患者分入有效组,疗效不佳的患者分入无效组,记录所有患者治疗前与治疗后3个月的临床疗效指标,并比较有效组和无效组患者的免疫学指标和临床疗效指标;比较病例组中巨块型患者和结节型患者的治疗有效率;记录治疗前后所有病例组患者病灶的超声造影检查(CEUS)及CT检查.结果 治疗前,病例组患者的血清热休克蛋白(HSP-70)和干扰素γ(IFN-γ)与白介素10(IL-10)的比值(IFN-γ/IL-10)分别为(18.78±4.53) ng/ml和(1.25±0.29),明显低于健康对照组[(20.26±4.16) ng/ml、(1.79±0.31)],而病例组的转化生长因子β(TGF-β)为(1.38 ±0.27) ng/ml,明显高于健康对照组[(1.10±0.17)ng/ml],组间差异均有统计学意义(P＜0.01).经HIFU治疗后1周和治疗后3个月,病例组患者的HSP-70[(21.93±5.28)和(20.71±4.66) ng/ml]、1FN-γ/IL-10[(1.68±0.34)和(1.49±0.28)]及TGF-β[(1.19 ±0.25)和(1.24±0.23)ng/ml]等免疫学指标均较组内治疗前明显好转(P＜0.05);病例组患者治疗前后的上述免疫学指标均差于健康对照组(P＜0.05).经HIFU治疗后3个月,病例组患者的目测类比法(VAS)评分[(3.53±0.86)分]和卡氏行为状态(KPS)评分[(79.12±20.49)分]以及血清总胆红素(TBIL)[(26.42±10.29) μmol/L]和甲胎蛋白(AFP)值[(84.82±21.51) ng/ml]均明显优于组内治疗前[(4.02±1.14)分和(68.94±18.35)分;(37.28±14.62) μmol/L和(265.39±87.45) ng/ml],且差异均有统计学意义(P＜0.05).病例组中,治疗有效组患者的全部上述指标均明显优于无效组(P＜0.05).另外,病例组中,巨块型患者的临床治疗总有效率为87.5％,明显高于结节型患者的66.67％,但二者之间的差异并无统计学意义(P＞0.05);影像学指标(CEUS和CT)显示HIFU治疗后肿瘤病灶血供消失,体积缩小.结论 HIFU能有效治疗原发性肝癌,同时能增强患者体内抗肿瘤免疫应答;相较于结节型患者,HIFU对于巨块型患者的疗效可能更好;CEUS可实时评估HIFU疗效.
目的 對高彊度聚焦超聲(HIFU)治療原髮性肝癌的免疫學效應以及影像學評估手段進行初步探討.方法 選取63例接受HIFU治療的肝癌患者作為病例組,另選39例健康誌願者作為對照組,記錄63例患者在HIFU治療前後的免疫學指標,併與健康對照組進行比較;病例組治療後3箇月,將臨床療效較好的患者分入有效組,療效不佳的患者分入無效組,記錄所有患者治療前與治療後3箇月的臨床療效指標,併比較有效組和無效組患者的免疫學指標和臨床療效指標;比較病例組中巨塊型患者和結節型患者的治療有效率;記錄治療前後所有病例組患者病竈的超聲造影檢查(CEUS)及CT檢查.結果 治療前,病例組患者的血清熱休剋蛋白(HSP-70)和榦擾素γ(IFN-γ)與白介素10(IL-10)的比值(IFN-γ/IL-10)分彆為(18.78±4.53) ng/ml和(1.25±0.29),明顯低于健康對照組[(20.26±4.16) ng/ml、(1.79±0.31)],而病例組的轉化生長因子β(TGF-β)為(1.38 ±0.27) ng/ml,明顯高于健康對照組[(1.10±0.17)ng/ml],組間差異均有統計學意義(P＜0.01).經HIFU治療後1週和治療後3箇月,病例組患者的HSP-70[(21.93±5.28)和(20.71±4.66) ng/ml]、1FN-γ/IL-10[(1.68±0.34)和(1.49±0.28)]及TGF-β[(1.19 ±0.25)和(1.24±0.23)ng/ml]等免疫學指標均較組內治療前明顯好轉(P＜0.05);病例組患者治療前後的上述免疫學指標均差于健康對照組(P＜0.05).經HIFU治療後3箇月,病例組患者的目測類比法(VAS)評分[(3.53±0.86)分]和卡氏行為狀態(KPS)評分[(79.12±20.49)分]以及血清總膽紅素(TBIL)[(26.42±10.29) μmol/L]和甲胎蛋白(AFP)值[(84.82±21.51) ng/ml]均明顯優于組內治療前[(4.02±1.14)分和(68.94±18.35)分;(37.28±14.62) μmol/L和(265.39±87.45) ng/ml],且差異均有統計學意義(P＜0.05).病例組中,治療有效組患者的全部上述指標均明顯優于無效組(P＜0.05).另外,病例組中,巨塊型患者的臨床治療總有效率為87.5％,明顯高于結節型患者的66.67％,但二者之間的差異併無統計學意義(P＞0.05);影像學指標(CEUS和CT)顯示HIFU治療後腫瘤病竈血供消失,體積縮小.結論 HIFU能有效治療原髮性肝癌,同時能增彊患者體內抗腫瘤免疫應答;相較于結節型患者,HIFU對于巨塊型患者的療效可能更好;CEUS可實時評估HIFU療效.
목적 대고강도취초초성(HIFU)치료원발성간암적면역학효응이급영상학평고수단진행초보탐토.방법 선취63례접수HIFU치료적간암환자작위병례조,령선39례건강지원자작위대조조,기록63례환자재HIFU치료전후적면역학지표,병여건강대조조진행비교;병례조치료후3개월,장림상료효교호적환자분입유효조,료효불가적환자분입무효조,기록소유환자치료전여치료후3개월적림상료효지표,병비교유효조화무효조환자적면역학지표화림상료효지표;비교병례조중거괴형환자화결절형환자적치료유효솔;기록치료전후소유병례조환자병조적초성조영검사(CEUS)급CT검사.결과 치료전,병례조환자적혈청열휴극단백(HSP-70)화간우소γ(IFN-γ)여백개소10(IL-10)적비치(IFN-γ/IL-10)분별위(18.78±4.53) ng/ml화(1.25±0.29),명현저우건강대조조[(20.26±4.16) ng/ml、(1.79±0.31)],이병례조적전화생장인자β(TGF-β)위(1.38 ±0.27) ng/ml,명현고우건강대조조[(1.10±0.17)ng/ml],조간차이균유통계학의의(P＜0.01).경HIFU치료후1주화치료후3개월,병례조환자적HSP-70[(21.93±5.28)화(20.71±4.66) ng/ml]、1FN-γ/IL-10[(1.68±0.34)화(1.49±0.28)]급TGF-β[(1.19 ±0.25)화(1.24±0.23)ng/ml]등면역학지표균교조내치료전명현호전(P＜0.05);병례조환자치료전후적상술면역학지표균차우건강대조조(P＜0.05).경HIFU치료후3개월,병례조환자적목측류비법(VAS)평분[(3.53±0.86)분]화잡씨행위상태(KPS)평분[(79.12±20.49)분]이급혈청총담홍소(TBIL)[(26.42±10.29) μmol/L]화갑태단백(AFP)치[(84.82±21.51) ng/ml]균명현우우조내치료전[(4.02±1.14)분화(68.94±18.35)분;(37.28±14.62) μmol/L화(265.39±87.45) ng/ml],차차이균유통계학의의(P＜0.05).병례조중,치료유효조환자적전부상술지표균명현우우무효조(P＜0.05).령외,병례조중,거괴형환자적림상치료총유효솔위87.5％,명현고우결절형환자적66.67％,단이자지간적차이병무통계학의의(P＞0.05);영상학지표(CEUS화CT)현시HIFU치료후종류병조혈공소실,체적축소.결론 HIFU능유효치료원발성간암,동시능증강환자체내항종류면역응답;상교우결절형환자,HIFU대우거괴형환자적료효가능경호;CEUS가실시평고HIFU료효.
Objective To evaluate immune modulation and the utility of high intensity focused ultrasound (HIFU) imaging for patients with hepatocellular carcinoma.Methods Sixty-three patients with hepatocellular carcinoma were treated using HIFU.Another 39 healthy volunteers served as a control group.A variety of immunological indexes were recorded before and after the treatment and 3 months later.The patients demonstrating good curative effect formed an effective group and those with poor curative effect were the ineffective group.The immunological and clinical indexes of the effective and ineffective groups were compared.The efficacy of the treatment for patients with giant blocks was compared with that for patients with nodular lesions.Contrast-enhanced ultrasono grams (CEUSs) and CT scans of the patients before and after HIFU were recorded.Results All of the immunological indexes [HSP,IFN-γ/IL-10 and TGF-β] were significantly better 1 week and 3 months after treatment than before treatment.Though all of course remained worse than those of the healthy controls throughout.The average indices in the effective group were also of course significantly better than those of the ineffective group,since that is how the groups were defined.Three months after the treatment had ended,self-reported pain,quality of life [Karnosky performance status],total bilirubin and tumor markers were all significantly better than before treatment.And there too the indexes of the effective group were still significantly better than those of the ineffective group.Efficacy was not significantly better among patients with giant blocks (87.5％) than among patients with nodular lesions (66.67％).The CEUS and CT images showed that after HIFU,blood supply to the neoplastic lesions had disappeared,and tumor volume had decreased.Conclusions HIFU is an effective treatment for hepatocellular carcinoma.It can improve patients' anti-tumor response.CEUS can be used to assess quickly the curative effect of HIFU.
