肿瘤坏死因子经肝动脉治疗原发性肝癌

Transcatheter arterial chemoembolization combined with tumor necrosis factor for primary hepatic cancer

目的:观察重组改构人肿瘤坏死因子(recombinant mutant human tumor necrosis factor,rmhTNF)经导管动脉内化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗原发性肝癌的近期疗效和不良反应。方法:将临床确诊的60例原发性肝癌患者随机分为治疗组(n=30)和对照组(n=30)。治疗组先行常规肝动脉灌注化疗,然后将导管插至肝肿瘤供血动脉,将rmhTNF、化疗药分别和超液态碘油充分乳化后进行动脉内栓塞;对照组不加rmhTNF行常规TACE治疗,1个月后重复治疗。2个疗程后评价介入术后不良反应及临床近期疗效。结果:介入治疗后治疗组较对照组肿瘤明显缩小,临床近期疗效差异有统计学意义(P<0.05)。介入术后2组肝功能损伤差异无统计学意义(P>0.05),但治疗组部分患者出现寒战。结论:TACE联合rmhTNF治疗原发性肝癌近期疗效良好,不良反应轻微,值得临床推广。

Objective：To observe and compare short-term therapeutic effect and adverse effect of recombinant mutant human tumor necrosis factor （rmhTNF） via transcatheter arterial chemoembolization in the treatment of primary hepatic cancer.Methods：Sixty patients with confirmed primary hepatic cancer in clinic were randomly divided into two groups （n=30）. Group A （therapeutic group） received conventional TACE first and then the catheter was inserted into the hepatic artery and rmhTNF, chemotherapeutic drugs, and hyper liquid iodide oil were emulsified and infused to induce intraarterial embobilization. Group B （control group） received one cycle of conventional TACE and the second cycle of conventional TACE 1 month later. After two cycles of interventional treatment the short-term therapeutic effect and adverse reaction of the two groups were evaluated. Results：Comparison of two groups, the tumor volume were obviously reduced in the therapeutic group. There was significant difference in the short-term therapeutic efficacy （P〈0.05）. But the difference had no statistical significance in the injury of liver function （P〉0.05）. Some patients experienced shiver after infusion of rmhTNF. Conclusion：TACE combined with rmhTNF is an effective method for primary hepatic cancer with good short-term outcome and no obvious adverse reaction. It is worthy of popularization in clinic.