125I粒子植入术联合吉西他滨TACE术治疗中晚期肝癌近期疗效及对肝功能、细胞免疫和预后的影响

Short-term efficacy of 125I seed implantation combined with gemcitabine TACE in the treatment of advanced hepatocellular carcinoma and its impact on liver function, cellular immunity, and prognosis

目的:探讨125I粒子植入术联合吉西他滨经肝动脉化疗栓塞术(TACE)治疗中晚期肝癌近期疗效及对肝功能、细胞免疫和预后的影响。方法:将2016年1月至2017年1月我院收治的84例中晚期肝癌患者按随机数字表法分为两组(各42例)。对照组患者予以吉西他滨TACE术,研究组在对照组基础上联合125I粒子植入术。治疗结束后比较两组患者近期疗效、肝功能、细胞免疫以及预后的具体情况。结果:研究组治疗总有效率(97.62%)明显高于对照组(85.71%)(χ2=4.525,P=0.033);治疗前,两组患者甲胎蛋白(AFP)及AST、ALT、TBIL等肝功能指标水平比较无差异(P>0.05);治疗后,两组AST、ALT、TBIL等3项指标水平比较无差异(P>0.05),研究组患者AFP水平低于对照组,差异具有统计学意义(t=11.301,P<0.001);治疗前后,两组患者CD4、CD8、CD4/CD8等细胞免疫水平比较无差异(P>0.05);治疗6个月后,研究组转移例数(4例,9.52%)明显低于对照组(12例,28.57%)(χ2=5.163,P=0.023)。术后12个月对两组患者进行随访,研究组存活率(97.62%)高于对照组(78.57%)(χ2=7.265,P=0.007)。结论:中晚期肝癌患者经125I粒子植入术与吉西他滨TACE术联合治疗后能够获得良好的临床疗效,患者近期疗效明显提高,并改善其肝功能以及免疫细胞水平,且患者预后较好,值得临床推广应用。

Objective:To investigate the short-term efficacy of 125I seed implantation combined with gemcitabine TACE in the treatment of advanced hepatocellular carcinoma and its impact on liver function,cellular immunity,and prognosis.Methods:A total of 84 patients with advanced hepatocellular carcinoma admitted to our hospital from January 2016 to January 2017 were involved in this study and were divided into two groups by random number table method.All 42 patients in each group were treated with gemcitabine TACE.The125I group received 125I seed implantation on the basis of gemcitabine TACE.After treatment,the short-term efficacy,liver function,cellular immunity and prognosis of the two groups were compared.Results:The total effective rate of the research group(97.62%)was significantly higher than that of control group(85.71%)(χ2=4.525,P=0.033).Before treatment,the levels of AFP,AST,ALT,TBIL and other liver function indicators in the two groups had no difference(P>0.05).After treatment,no indices showed difference between the two groups except for AFP(t=11.301,P<0.001).Whether before or after treatment,no difference was found between the two groups in CD4 and CD8 T cell counts(all P>0.05).Six months after treatment,the cases with metastases in125 I group(4 cases,9.52%)was significantly fewer than that in control group(12 cases,28.57%)(χ2=5.163,P=0.023).The survival rate of 125I group(97.62%)was higher than that of control group(78.57%)(χ2=7.265,P=0.007).Conclusion:125I seed implantation combined with gemcitabine TACE has a good clinical effect in patients with advanced hepatocellular carcinoma,which can significantly improve the short-term efficacy of patients,improve their liver function and immune cell level,with good prognosis.It is worthy of clinical application.