药物敏感试验指导肺癌合并恶性胸腔积液的顺铂联合其他药物胸腔内化疗

Intrapleural chemotherapy for malignant pleural effusion of lung cancer based on the drug sensitivity test of cisplatin combined with other agents

目的用药物敏感试验预测肺癌合并恶性胸腔积液癌细胞对顺铂联合其他药物的敏感度，观察其在指导此类患者的顺铂联合其他化疗药物胸腔内化疗的价值。方法将44例胸腔积液癌细胞阳性肺癌患者随机分为两组：药物敏感试验组（20例，有2例因体外药物敏感试验失败而被排除）和对照组（22例）。药物敏感试验组患者用三磷酸腺苷-肿瘤细胞药物敏感试验（ATP-TCA）法分别检测胸腔积液癌细胞对顺铂加香菇多糖、顺铂加甘露聚糖肽、顺铂加A群链球菌制剂、顺铂加干扰素、顺铂加金黄色葡萄球菌滤液制剂、顺铂加卡介苗多糖核酸、顺铂加红色诺卡菌细胞壁骨架、顺铂加白细胞介素-2的敏感度，并选择抑瘤率最高的联合化疗药物对患者进行胸腔内化疗，观察治疗后胸腔积液完全缓解率及胸腔积液癌细胞转阴率，并与对照组比较。结果药物敏感试验组患者对各联合化疗药物敏感的例数为：顺铂加香菇多糖14例、顺铂加甘露聚糖肽18例、顺铂加A群链球菌制剂17例、顺铂加干扰素10例、顺铂加金黄色葡萄球菌滤液制剂16例、顺铂加卡介苗多糖核酸15例、顺铂加红色诺卡菌细胞壁骨架17例、顺铂加白细胞介素-216例。药物敏感试验组完全缓解率为65．0％，对照组为27．3％（P〈0．05）。药物敏感试验组胸腔积液癌细胞转阴率为80．0％，对照组为45．5％（P〈0．05）。结论用药物敏感试验指导肺癌合并恶性胸腔积液的胸腔内个体化化疗可提高完全缓解率和胸腔积液癌细胞转阴率，该方法具有临床实用价值。

Objective To estimate the sensitivity of malignant cells from pleural effusion of lung cancer to cisplatin combined with other agents by in vitro sensitivity test, and to study its value in individualized intrapleural chemotherapy. Methods Forty-four cases of lung cancer with malignant pleura/effusion were divided into two groups randomly：drug sensitivity test group （20 cases, discard 2 cases who were defeated in drug sensitivity test） and control group （22 cases）. The sensitivities of malignant cells to cisplatin and lentinan, cisplatin and mannatide,cisplatin and group A streptococcus preparation, cisplatin and interferon,cisplatin and staphylococcus aureus culture filtrate, cisplatin and BCG polysaccharide and nucleic acid preparation, cisplatin and Nocadia rubra cell wall skeleton （N-CWS）, cisplatin and interleukin-2 by ATP - TCA were detected,and one of the most sensitive drugs was applied to intrapleural chemotherapy by drug sensitivity test group. The rates of the patients with complete remission and with disappearance of pleural effusion cancer cells in the drug sensitivity test group were compared with the patients in control group who all were treated with cisplatin. Results In drug sensitivity test group, the sensitive cases to cisplatin and lenti- nan, cisplatin and mannatide, cisplatin and group A streptococcus preparation, cisplatin and interferon, cisplatin and staphylococcus aureus culture filtrate, cisplatin and BCG polysaccharide and nucleic acid preparation,cisplatin and N-CWS,cisplatin and interleukin-2 were 14,18,17,10,16,15,17 and 16 cases respectively. The rates of patients with complete remission and disappearance of pleural effusion cancer cell in the drug sensitivity test group were significandy higher than those in control group （65.0% and 27.3%, 80.0% and 45.5%）. Conclusion Individualized intrapleural chemotherapy based on the results of drug sensitivity test can improve the therapeutic efficacy of malignant pleural effusion from lung cancer.