CAJ | 학술논문

目的：恶性胸腔积液（ malignant pleural effusion ， MPE）严重危害晚期肺癌患者生存质量，目前对其尚无理想治疗方法。文中回顾性分析重组改构人肿瘤坏死因子（ recombinant human mutant tumor necrosis factor-alpha， rhu-TNF）治疗肺腺癌所致MPE的临床疗效与不良反应。方法回顾性收集2013年3月至2014年7月南京军区南京总医院呼吸与危重症医学科确诊的肺腺癌所致恶性胸膜腔积液患者70例，常规胸腔积液引流后，根据3～4万单位／kg分别以200万单位和300万单位剂量行胸腔内注射rhu-TNF，观察其疗效及不良反应。结果200万单位和300万单患者有效率分别为75．68％和87．88％，差异无统计学意义（P＝0．23）。注药前使用地塞米松的患者不良反应比不使用者明显减轻，差异有统计学意义（P＝0．021），但地塞米松的使用对rhu-TNF的疗效无影响（P＝0．486）。结论 rhu-TNF是治疗肺腺癌所致MPE的高效、安全药物。地塞米松可减轻患者不良反应且不影响rhu-TNF疗效。
목적：악성흉강적액（ malignant pleural effusion ， MPE）엄중위해만기폐암환자생존질량，목전대기상무이상치료방법。문중회고성분석중조개구인종류배사인자（ recombinant human mutant tumor necrosis factor-alpha， rhu-TNF）치료폐선암소치MPE적림상료효여불량반응。방법회고성수집2013년3월지2014년7월남경군구남경총의원호흡여위중증의학과학진적폐선암소치악성흉막강적액환자70례，상규흉강적액인류후，근거3～4만단위／kg분별이200만단위화300만단위제량행흉강내주사rhu-TNF，관찰기료효급불량반응。결과200만단위화300만단환자유효솔분별위75．68％화87．88％，차이무통계학의의（P＝0．23）。주약전사용지새미송적환자불량반응비불사용자명현감경，차이유통계학의의（P＝0．021），단지새미송적사용대rhu-TNF적료효무영향（P＝0．486）。결론 rhu-TNF시치료폐선암소치MPE적고효、안전약물。지새미송가감경환자불량반응차불영향rhu-TNF료효。
Objective The study aimed to observe the clinical effects and the adverse reactions of recombinant mutant human tumor necrosis factor-alpha ( rhu-TNF) on the treatment of malignant pleural effusion ( MPE) induced by lung adenocarcinoma . Methods 70 patients with MPE caused by lung adenocarcinoma hospitalized in our department were chosen as the research objects . After conventional drainage of pleural effusion , the patients were divided into two groups according to the weight , respectively receiving intra pleural injection of 2 000 000 units and 3 000 000 units of rhu-TNF, followed by the observation of clinical effects and adverse reac-tions.A further retrospective analysis were made on the effects of dexamethasone injected before operation on clinical effects and ad -verse events. Results The effective rates of 2 000 000 unit group and 3 000 000 unit group were respectively 75.68%and 87.88%(P=0.23), with no statistical difference.The adverse reactions in the group of patients being injected dexamethasone before operation significantly reduced(P=0.021) and the use of dexamethasone had no influence on the efficacy of rhu-TNF ( P=0 .486 ) . Conclusion Rhu-TNF is a safe drug with high efficiency in the treatment of MPE induced by lung adenocarcinoma , and the efficacy and safety of re-peated application in clinic still need more supporting data .