CAJ | 학술논문

目的：研究超声引导下射频消融术联合树突状细胞（DC）‐细胞因子诱导的杀伤细胞（CIK）治疗中晚期肝细胞癌患者的临床疗效。方法选取100例诊断为中晚期肝细胞癌的患者随机分为治疗组与对照组，每组各50例。两组患者均给予 DC‐CIK 免疫细胞治疗，治疗组在细胞治疗的基础上行超声引导下经皮腹腔穿刺射频消融术，观察两组临床疗效、不良反应与治疗前后外周血清肿瘤标志物的浓度及免疫功能。结果治疗后治疗组近期及远期临床疗效均优于对照组（P ＜0．05）；治疗后两组外周血清甲胎蛋白（AFP）、H‐亚基铁蛋白（HF）、癌胚抗原（CEA）、糖类抗原199（CA199）水平较治疗前有所降低（P＜0．05）。治疗组外周血清 CD3、CD8、CD56／CD3、CD16／CD3、IgG 、IgM 、IgA 较治疗前有所升高（P＜0．05），CD4／CD8较治疗前降低（P ＜0．05），CD4较治疗前无明显改变（P＞0．05）。对照组外周血清 CD3、CD8、CD4、CD4／CD8、CD56／CD3、CD16／CD3较治疗前无有所升高（P＜0．05），对照组 IgG 、IgM 、IgA 较治疗前升高（P＜0．05）。治疗后治疗组外周血清 AFP 、HF 、CEA 、CA199浓度均低于对照组（P＜0．05）；治疗组外周血清 CD3、CD8、CD56／CD3、CD16／CD3、IgG 、IgM 、IgA 明显高于对照组（P＜0．05），CD4／CD8明显低于对照组（P＜0．05），CD4较对照组差异无统计学意义（P＞0．05）。两组治疗中均出现发热、寒战伴高热、皮疹；治疗组术后出现腹痛、恶心伴呕吐、肝周血肿。结论超声引导下射频消融术联合 DC‐CIK 能提高中晚期肝细胞癌患者的临床疗效且不良反应较小。在治疗过程中全面、细致、规范的护理是治疗成功的重要前提。
목적：연구초성인도하사빈소융술연합수돌상세포（DC）‐세포인자유도적살상세포（CIK）치료중만기간세포암환자적림상료효。방법선취100례진단위중만기간세포암적환자수궤분위치료조여대조조，매조각50례。량조환자균급여 DC‐CIK 면역세포치료，치료조재세포치료적기출상행초성인도하경피복강천자사빈소융술，관찰량조림상료효、불량반응여치료전후외주혈청종류표지물적농도급면역공능。결과치료후치료조근기급원기림상료효균우우대조조（P ＜0．05）；치료후량조외주혈청갑태단백（AFP）、H‐아기철단백（HF）、암배항원（CEA）、당류항원199（CA199）수평교치료전유소강저（P＜0．05）。치료조외주혈청 CD3、CD8、CD56／CD3、CD16／CD3、IgG 、IgM 、IgA 교치료전유소승고（P＜0．05），CD4／CD8교치료전강저（P ＜0．05），CD4교치료전무명현개변（P＞0．05）。대조조외주혈청 CD3、CD8、CD4、CD4／CD8、CD56／CD3、CD16／CD3교치료전무유소승고（P＜0．05），대조조 IgG 、IgM 、IgA 교치료전승고（P＜0．05）。치료후치료조외주혈청 AFP 、HF 、CEA 、CA199농도균저우대조조（P＜0．05）；치료조외주혈청 CD3、CD8、CD56／CD3、CD16／CD3、IgG 、IgM 、IgA 명현고우대조조（P＜0．05），CD4／CD8명현저우대조조（P＜0．05），CD4교대조조차이무통계학의의（P＞0．05）。량조치료중균출현발열、한전반고열、피진；치료조술후출현복통、악심반구토、간주혈종。결론초성인도하사빈소융술연합 DC‐CIK 능제고중만기간세포암환자적림상료효차불량반응교소。재치료과정중전면、세치、규범적호리시치료성공적중요전제。
Objective To investigate the clinical efficacy of radiofrequency ablation combined with DC‐CIK in treating moderate and advanced hepatocellular caicinoma and its nursing experience .Methods 100 cases diagnosed as moderate and advanced hepatocellular caicinoma were selected and randomly divided into the treatment group and the control group ,50 cases in each group .The two groups were given the immune cell therapy of DC‐CIK ,while on this basis the treatment group was performed the radiofrequency ablation by percutaneous abdominal paracentesis under ultrasound guiding .The clinical efficacy ,adverse reactions and peripheral serum concentrations of tumor markers and immune function before and after treatment were observed in the two groups .Results The short term and long‐term clinical efficacies after treatment in the treatment group were significantly better than those in the control group(P<0 .05) ;peripheral blood AFP ,HF ,CEA and CA199 levels after treatment in the two groups were decreased compared with before treatment(P< 0 .05) ;peripheral serum CD3 ,CD8 ,CD56/CD3 ,CD16/CD3 ,IgG ,IgM and IgA after treat‐ment in the treatment group were increased compared with before treatment (P < 0 .05) ,while CD4/CD8 was de‐creased compared with before treatment(P< 0 .05) ,CD4 had no change compared with before treatment(P> 0 .05) . Peripheral serum CD3 ,CD8 ,CD4 ,CD4/CD8 ,CD56/CD3 ,CD16/CD3 after treatment in the control group were in‐creased compared with before treatment(P< 0 .05) ,the IgG ,IgM and IgA levels after treatment were increased com‐pared with before treatment (P < 0 .05) .Peripheral serum AFP ,HF ,CEA and CA199 levels after treatment in the treatment group were lower than those in the control group(P < 0 .05) ;while peripheral serum CD3 ,CD8 ,CD56/CD3 ,CD16/CD3 ,IgG ,IgM and IgA were significantly higher than those in the control group(P< 0 .05) ,serum CD4/CD8 was significantly lower than that in the control group(P< 0 .05) and CD4 had no significant difference compared with the control group .Fever and chills complicating rashes occurred during treatment in the two groups ;the treat‐ment group appeared abdominal pain ,nausea ,vomiting ,peripheral hepatic hematoma .Conclusion Radiofrequency ab‐lation guided by ultrasound combined with DC‐CIK can increase the clinical efficiency in the patients with moderate and advanced hepatocellular caicinoma and has less adverse reactions .The comprehensive ,careful and normative nurs‐ing care is an important precondition of treatment success .