小牛脾提取物注射液联合胸膜腔局部化疗治疗恶性胸腔积液的临床观察

Treatment of malignant pleural effusion with calf spleen extract injection combined with pleural cavity chemotherapy

目的探讨小牛脾提取物注射液联合胸膜腔局部化疗治疗恶性胸腔积液(MPE)的近期疗效和副反应。方法 100例MPE患者,采用随机数字表法分为观察组和对照组,均行中心静脉导管胸膜腔置管引流胸水,其后给予胸膜腔200万u白细胞介素-2(IL-2)+50 mg/次顺铂(DDP)灌注治疗,注射1次/7 d,连续注射2次。观察组加用小牛脾提取物注射液10 ml静脉滴注1次/d,共14 d。观察两组的治疗效果、生活质量评分(KPS)、免疫功能变化及副反应。结果观察组有效率为88%,优于对照组的72%(P<0.05)。观察组治疗后KPS评分改善率为72%,对照组改善率为48%,两组比较差异有统计学意义(P<0.05)。两组患者治疗后CD3+、CD4+升高,CD4+/CD8+、NK细胞比值上升,与治疗前比较,差异有统计学意义(P<0.05),治疗后观察组与治疗组比较差异有统计学意义(P<0.05);观察组呕吐纳差反应发生率低于对照组,两组比较差异有统计学意义(P<0.05),胸痛、发热发生率两组比较差异无统计学意义(P>0.05)。结论小牛脾提取物注射液联合胸膜腔局部化疗治疗MPE能减轻消化道反应,增强免疫力,提高生活质量和治疗效果,值得临床推广应用。

Objective To investigate the short-term efficacy and side effects of calf spleen extract injection combined with pleural cavity chemotherapy in the treatment of malignant pleural effusion. Methods A total of 100 patients with malignant pleural effusion were randomly divided into observation group and control group. All the patients were treated with central venous catheter drainage of pleural effusion. Then IL-2 at a dose of 2,000,000 u each time was injected intrapleurally combined with DDP 50 mg each time. The above dose was given once every 7 d for twice. The observation group had additional intravenous drip of calf spleen extract injection 10 ml every day for 14 days of treatment. The treatment effect, quality of life（Karnofsky point system, KPS） score, immune function changes and adverse reactions were observed in both groups.Results The effective rate of the observation group was 88.0%, which was higher than 72.0% of the control group（P〈0.05）. After treatment, the improvement rate of the KPS score was 72.0% in the observation group and 48.0% in the control group, the difference was significant（P〈0.05）. In both groups, the CD3＋, CD4＋,CD4＋/CD8＋and NK cells increased after treatment, there were significant differences compared with those before treatment（P〈0.05）; and the indexes after treatment were significantly different between the observation group and the control group（P〈0.05）. The incidence of nausea and vomiting in the observation group was significantly lower than that in the control group（P〈0.05）. There was no significant difference in the incidence of chest pain or fever between the two groups（P〈0.05）. Conclusions Calf spleen extract injection combined with pleural cavity local chemotherapy can reduce gastrointestinal reaction, enhance immunity, and improve the quality of life and effect of treatment for malignant pleural effusion. It is worthy of clinical application.