CAJ | 학술논문

目的观察顺铂联合甘露聚糖肽胸腔灌注治疗鼻咽癌恶性胸腔积液的疗效及患者不良反应.方法鼻咽癌伴恶性胸腔积液患者47例,年龄41 ～ 70岁,中位年龄50岁；单侧发生胸腔积液45例(95.7％),双侧2例(4.3％).胸腔穿刺外周静脉置人中心静脉导管引流后胸腔灌注顺铂(30 mg/次)和甘露聚糖肽(15 mg/次),观察疗效及不良反应,记录生存期.结果全组患者完全缓解(CR)17例(36.2％),部分缓解(PR)21例(44.7％),总有效(CR+PR)率80.9％.全组中位生存时间10.5个月.胸腔积液pH值≥7.2、葡萄糖≥60 mg/L、乳酸脱氢酶(LDH)＜600U/L的患者应用本方案治疗的有效率分别为85.0％(34/40)、86.5％(32/37)、89.5％(34/38),中位生存期分别为11.5、12.0、12.5个月,与胸腔积液pH值＜7.2、葡萄糖＜60mg/L、LDH≥600 U/L者[有效率分别为42.8％(3/7)、50.0％(5/10)、44.4％(4/9),中位生存期分别为6.5、6.5、6.0个月]比较,差异均有统计学意义(均P＜ 0.05)；伴骨转移和(或)肺转移而无肝转移者和有肝转移者有效率分别为47.0％(16/34)、57.1％(4/7),差异无统计学意义(x2=0.01,P=0.29),二者中位生存期分别为11.0、6.0个月,差异有统计学意义(P=0.02).Cox多因素分析证实,积液LDH值可作为判断其预后的独立因素.常见不良反应较轻,包括发热、胸痛、恶心、呕吐.结论顺铂联合甘露聚糖肽胸腔灌注治疗鼻咽癌恶性胸腔积液疗效满意,不良反应轻；积液LDH值是判断预后的一个独立影响因素,伴有肝转移患者的中位生存期短.
목적 관찰순박연합감로취당태흉강관주치료비인암악성흉강적액적료효급환자불량반응.방법 비인암반악성흉강적액환자47례,년령41 ～ 70세,중위년령50세；단측발생흉강적액45례(95.7％),쌍측2례(4.3％).흉강천자외주정맥치인중심정맥도관인류후흉강관주순박(30 mg/차)화감로취당태(15 mg/차),관찰료효급불량반응,기록생존기.결과 전조환자완전완해(CR)17례(36.2％),부분완해(PR)21례(44.7％),총유효(CR+PR)솔80.9％.전조중위생존시간10.5개월.흉강적액pH치≥7.2、포도당≥60 mg/L、유산탈경매(LDH)＜600U/L적환자응용본방안치료적유효솔분별위85.0％(34/40)、86.5％(32/37)、89.5％(34/38),중위생존기분별위11.5、12.0、12.5개월,여흉강적액pH치＜7.2、포도당＜60mg/L、LDH≥600 U/L자[유효솔분별위42.8％(3/7)、50.0％(5/10)、44.4％(4/9),중위생존기분별위6.5、6.5、6.0개월]비교,차이균유통계학의의(균P＜ 0.05)；반골전이화(혹)폐전이이무간전이자화유간전이자유효솔분별위47.0％(16/34)、57.1％(4/7),차이무통계학의의(x2=0.01,P=0.29),이자중위생존기분별위11.0、6.0개월,차이유통계학의의(P=0.02).Cox다인소분석증실,적액LDH치가작위판단기예후적독립인소.상견불량반응교경,포괄발열、흉통、악심、구토.결론 순박연합감로취당태흉강관주치료비인암악성흉강적액료효만의,불량반응경；적액LDH치시판단예후적일개독립영향인소,반유간전이환자적중위생존기단.
Objective To evaluate the efficacy of thoracic cavity perfusion with cisplatin combined with mannan peptide in nasopharyngeal carcinoma patients with malignant pleural effusion.Methods 47 cases of nasopharyngeal carcinoma patients with malignant pleural effusion with a median age of 50 years old (41-70 years old) were enrolled.Pleural effusion occurred at 38.5 months on average after diagnosis,unilateral effusion was seen in 45 patients (95.7 ％),bilateral effusion was seen in 2 patients (4.2 ％).Cisplatin combined with mannan peptide was administered through pleural puncture by PICC center vein pipe after drainage.Data of survival complications and response to the treatment were reviewed.Results 17 patients (36.1％) had a complete remission (CR),21 patients (44.6 ％) had partial remission (PR),and the total remission rate (CR+ PR) was 80.9 ％.The median survival time was 10.5 months.Patients with pleural fluid pH ≥ 7.2,glucose ≥ 60 mg/L,and lactic dehydrogenase (LDH) ＜ 600 U/L showed association with good efficacy,the efficacy rates were 85.0 ％ (34/40),86.5 ％ (32/37),89.5 ％ (34/38),the median survival time were 11.5,12.0,12.5 months.Pleural fluid pH ＜ 7.2,glucose ＜ 60 mg/L,and LDH ≥ 600 U/L showed association with poor efficacy,the efficacy rates were 42.8 ％ (3/7),50.0 ％ (5/10),44.4 ％ (4/9),the median survival time were 6.5,6.5,6.0 months (P ＜ 0.05).The curative effect of the patients with bone metastasis and (or) pulmonary metastasis without liver metastasis was more similar with that of the patients with liver metastases [(47.0 ％ (16/34) vs 57.1％ (4/7),x2 =0.01,P =0.29].But median survival time had significant difference (11.0 vs 6.0 months,P =0.02).The Cox multi-factor analysis confirmed that the LDH value of effusion was an independent factor as prognosis evaluation.Major side effects of the treatment included fever,chest pain,nausea and vomiting.Conclusion Thoracic cavity perfusion using cisplatin combined with mannan peptide is effective in the treatment of malignant pleural effusion in nasopharyngeal carcinoma patients with pleural effusion,with relatively low toxicity.LDH value is a predictive factor for survival.The patients with liver metastases appeare poor median survival time.