恶性胸腔积液不同治疗方法的效果比较

The comparison observation of different clinical treatment on malignant pleural effusion

目的探讨三种不同方法治疗恶性胸腔积液的临床疗效。方法98例恶性胸腔积液的患者，随机分为博来霉素组（BLM组）、联用乌体林斯组（BLM＋UTL组）及联用白介素组（BLM＋IL组）。BLM组（31例），胸腔内注入博来霉素；BLM＋UTL组（32例），胸腔内注入博来霉素和乌体林斯；BLM＋IL组（35例），胸腔内注入博来霉素和白介素-2。1个疗程结束后评价患者的近期疗效、行为状况和不良反应，并检测治疗前后胸腔积液中癌胚抗原（CEA）和肿瘤坏死因子（TNF）的水平变化。结果BLM＋UTL组及BLM＋IL组的近期疗效、行为状况改善程度均优于BLM组（P〈0．05）；三组治疗后胸腔积液中的CEA显著低于治疗前（均P〈0．01），BLM＋UTL组及BLM＋IL组治疗后CEA水平与BLM组比较差异有统计学意义（均P〈0．01）；BLM＋UTL组及BLM＋IL组治疗后TNF与治疗前比较均有明显升高（P〈0．01），两组治疗后TNF水平与BLM组的比较差异有统计学意义（P〈0．01）。结论胸腔内注入博来霉素联用乌体林斯或博来霉素联用白介素-2比单用博来霉素治疗恶性胸腔积液更为有效。

Objective To compare the efficacy and the side-effect of three different ways in treating the patients with malignant pleural effusion. Methods 98 patients histologically proved malignant pleural effusion were randomly divided into three groups, bleomycin group （BLM）, bleomycin with mycobacterium group （BLM ＋ UTL） and blemycin with intertleukin-2 （ BLM ＋ IL）. 31 patients were treated with bleomycin intrapleural injection in BLM group,32 patients were treated with bleomycin and Utilin＇s （mycobacterium） intrapleural injection in BLM ＋ ULL group and 35 patients were treated with bleomycin and interdeukin-2 intrapleural injection in BLM ＋ IL group. The therapeutic efficacy, change of performance and side effects were compared among the three groups after one period of treatment. The changes of CEA and TNF in the pleural effusion were examined before and after treatment. Results The therapeutic efficacy and performance improvement were higher in BLM ＋ UTL and BLM ＋ IL group than that of BLM group（P 〈0. 05） ,the pleural CEA of post-treatment in three groups were lower than that of pre-treatment（P 〈 0. 01） ,the CEA after treatment in BLM ＋ UTL group and BLM ＋ IL group was lower than that of BLM group（P 〈 0. 01 ,respectively）. The pleural TNF of post-treatment in BLM ＋ UTL and BLM ＋ IL groups was higher than that of pre-treatment（P 〈0. 01 ） in BLM group. The pleural TNF of post-treatment in BLM ＋ UTL and BLM ＋ IL group was higher than that of BLM group（P 〈 0. 01 ）. Conclusion Intrapleural injection of mycobacterium with bleomycin or interlekin-2 with bleomycin has better efficacy than using bleomycin only in treating malignant pleural effusion.