疑难病杂志
疑難病雜誌
의난병잡지
JOURNAL OF DIFFICULT AND COMPLICATED CASES
2015年
9期
939-943
,共5页
张平%李春田%马明%张伟
張平%李春田%馬明%張偉
장평%리춘전%마명%장위
原发性肝癌%重组人血管内皮抑素%经导管肝动脉化疗栓塞%甲胎蛋白%血管内皮生长因子%生存时间
原髮性肝癌%重組人血管內皮抑素%經導管肝動脈化療栓塞%甲胎蛋白%血管內皮生長因子%生存時間
원발성간암%중조인혈관내피억소%경도관간동맥화료전새%갑태단백%혈관내피생장인자%생존시간
Primary hepatocellular carcinoma%Recombinant human endostatin%Transcatheter arterial chemoemboliza-tion%Alpha fetoprotein%Vascular endothelial growth factor%Survival time
目的：比较重组人血管内皮抑素（rh-ES）联合经导管肝动脉化疗栓塞（TACE）与单纯TACE治疗中晚期原发性肝癌（ PHC）的临床疗效。方法中晚期PHC患者85例行TACE治疗，根据TACE前后是否应用rh-ES注射液分为观察组（45例）、对照组（40例），对比2组TACE术后近期疗效、血清标志物[甲胎蛋白（AFP）、胰岛素样生长因子II（IGF-II）、胰岛素样生长因子结合蛋白-2（TGFBP-2）、血管内皮生长因子（VEGF）]水平及化疗期间药物不良反应，随访观察2组患者生存时间。结果观察组总体有效率为20．0％，临床获益率为88．9％，均高于对照组的12．5％、80．0％，差异均无统计学意义（χ2＝0．866、1．292， P ＞0．05）。与术前比较，2组TACE术后2个月，患者血清AFP、IGF-II、IGFBP-2、VEGF水平均明显下降（ t 观＝20．658、12．453、14．597、21．797， t 对＝15．374、7．950、10．968、11．091， P ＜0．05）；观察组治疗后上述指标水平均显著低于对照组，差异有统计学意义（ t ＝2．870、8．123、2．714、6．994， P ＜0．05）。2组骨髓抑制、胃肠道反应、肝功能损害、发热等常见毒性反应发生率无明显差异（ P ＞0．05），观察组注射rh-ES后心律失常发生率（11．1％）高于对照组（2．5％），差异无统计学意义（ P ＞0．05）。观察组和对照组TACE术后中位生存时间分别为（21．0±1．1）个月、（15．0±1．3）个月，2组生存时间比较差异有统计学意义（χ2＝4．227， P ＝0．040）。观察组TACE术后12个月生存率为80．0％、24个月生存率为42．2％均高于对照组的67．5％、27．5％，但差异均无统计学意义（χ2＝1．725， P ＝0．189；χ2＝2．010， P ＝0．156）。结论 TACE基础上联合应用rh-ES治疗中晚期PHC，能抑制肿瘤血管的生成，提高近期疗效与远期生存时间；rh-ES使用过程中要注意对心血管系统的毒性作用。
目的：比較重組人血管內皮抑素（rh-ES）聯閤經導管肝動脈化療栓塞（TACE）與單純TACE治療中晚期原髮性肝癌（ PHC）的臨床療效。方法中晚期PHC患者85例行TACE治療，根據TACE前後是否應用rh-ES註射液分為觀察組（45例）、對照組（40例），對比2組TACE術後近期療效、血清標誌物[甲胎蛋白（AFP）、胰島素樣生長因子II（IGF-II）、胰島素樣生長因子結閤蛋白-2（TGFBP-2）、血管內皮生長因子（VEGF）]水平及化療期間藥物不良反應，隨訪觀察2組患者生存時間。結果觀察組總體有效率為20．0％，臨床穫益率為88．9％，均高于對照組的12．5％、80．0％，差異均無統計學意義（χ2＝0．866、1．292， P ＞0．05）。與術前比較，2組TACE術後2箇月，患者血清AFP、IGF-II、IGFBP-2、VEGF水平均明顯下降（ t 觀＝20．658、12．453、14．597、21．797， t 對＝15．374、7．950、10．968、11．091， P ＜0．05）；觀察組治療後上述指標水平均顯著低于對照組，差異有統計學意義（ t ＝2．870、8．123、2．714、6．994， P ＜0．05）。2組骨髓抑製、胃腸道反應、肝功能損害、髮熱等常見毒性反應髮生率無明顯差異（ P ＞0．05），觀察組註射rh-ES後心律失常髮生率（11．1％）高于對照組（2．5％），差異無統計學意義（ P ＞0．05）。觀察組和對照組TACE術後中位生存時間分彆為（21．0±1．1）箇月、（15．0±1．3）箇月，2組生存時間比較差異有統計學意義（χ2＝4．227， P ＝0．040）。觀察組TACE術後12箇月生存率為80．0％、24箇月生存率為42．2％均高于對照組的67．5％、27．5％，但差異均無統計學意義（χ2＝1．725， P ＝0．189；χ2＝2．010， P ＝0．156）。結論 TACE基礎上聯閤應用rh-ES治療中晚期PHC，能抑製腫瘤血管的生成，提高近期療效與遠期生存時間；rh-ES使用過程中要註意對心血管繫統的毒性作用。
목적：비교중조인혈관내피억소（rh-ES）연합경도관간동맥화료전새（TACE）여단순TACE치료중만기원발성간암（ PHC）적림상료효。방법중만기PHC환자85례행TACE치료，근거TACE전후시부응용rh-ES주사액분위관찰조（45례）、대조조（40례），대비2조TACE술후근기료효、혈청표지물[갑태단백（AFP）、이도소양생장인자II（IGF-II）、이도소양생장인자결합단백-2（TGFBP-2）、혈관내피생장인자（VEGF）]수평급화료기간약물불량반응，수방관찰2조환자생존시간。결과관찰조총체유효솔위20．0％，림상획익솔위88．9％，균고우대조조적12．5％、80．0％，차이균무통계학의의（χ2＝0．866、1．292， P ＞0．05）。여술전비교，2조TACE술후2개월，환자혈청AFP、IGF-II、IGFBP-2、VEGF수평균명현하강（ t 관＝20．658、12．453、14．597、21．797， t 대＝15．374、7．950、10．968、11．091， P ＜0．05）；관찰조치료후상술지표수평균현저저우대조조，차이유통계학의의（ t ＝2．870、8．123、2．714、6．994， P ＜0．05）。2조골수억제、위장도반응、간공능손해、발열등상견독성반응발생솔무명현차이（ P ＞0．05），관찰조주사rh-ES후심률실상발생솔（11．1％）고우대조조（2．5％），차이무통계학의의（ P ＞0．05）。관찰조화대조조TACE술후중위생존시간분별위（21．0±1．1）개월、（15．0±1．3）개월，2조생존시간비교차이유통계학의의（χ2＝4．227， P ＝0．040）。관찰조TACE술후12개월생존솔위80．0％、24개월생존솔위42．2％균고우대조조적67．5％、27．5％，단차이균무통계학의의（χ2＝1．725， P ＝0．189；χ2＝2．010， P ＝0．156）。결론 TACE기출상연합응용rh-ES치료중만기PHC，능억제종류혈관적생성，제고근기료효여원기생존시간；rh-ES사용과정중요주의대심혈관계통적독성작용。
Objective To compare the clinical curative effect of recombinant human endostatin ( rh-ES) combined with transcatheter arterial chemoembolization ( TACE) and single TACE in the treatment of advanced primary hepatocellular carcinoma(PHC).Methods 85 cases of advanced PHC patients underwent TACE treatment.According to whether applied the injection of rh-ES before and after TACE, they were divided into observation group (45 cases), control group (40 cases). Two groups’ TACE postoperative curative effect in the near future were compared , serum marker [alpha fetal protein (AFP), insulin like growth factor II (IGF-II) , insulin like growth factor binding protein 2 (TGFBP-2), vascular endothelial growth factor ( VEGF) ] and chemotherapy drug adverse reaction were compared between the two groups. All patients were followed up for survival time .Results Observation group ’ s overall efficiency was 20.0%, and clinical benefit rate was 88.9%, which was higher than the 12.5% and 80.0% in the control group, the difference was not statistically significant (χ2 =0.866,χ2 =1.292, P >0.05).Compared with the preoperative, 2 months after TACE operation, serum AFP, IGF-II, IG-FBP 2 and VEGF levels were significantly decreased in both of the two groups (observation group:t =20.658, t =12.453, t=14.597, t =21.797, control group:t =15.374, t =7.950, t =10.968, t =11.091, P <0.05);after treatment, obser-vation group ’ s indexes level were significantly lower than those of the control group , the difference were statistically significant ( t =2.870, t =8.123, t =2.714, t =6.994, P <0.05).Two groups’ bone marrow suppression, gastrointestinal tract reaction, liver function damage, fever and other common toxicity reaction rate had no significant difference ( P >0.05), the observation group after injected rh-ES’ s arrhythmia occurred rate was 11.1%, which was higher than that of the control group’s 2.5%, the difference was not statistically significant ( P >0.05).The observation group and the control group after TACE’s median follow-up time was(21.0 ±1.1) months and (15.0 ±1.3) months, the difference in survival time between the two groups has statistical significance (χ2 =4.227, P =0.040).In the observation group, TACE postoperative 12 months’ survival rate was 80.0%, 24 months’ survival rate was 42.2%, which were higher than those of control group ’ s 67.5%and 27.5%, but the differences were no statistical significance (χ2 =1.725, P =0.189;χ2 =2.010, P =0.156). Conclusion Transcatheter arterial chemoembolization ( TACE) combined application of rh-ES in the treatment of advanced PHC can inhibit the formation of tumor blood vessels , improve the short-term effects and long-term survival time;toxic effects on the cardiovascular system should be noticed during using rh-ES.
