重组人血管内皮抑制素联合顺铂胸腔灌注治疗恶性胸腔积液的临床观察

Clinical observation on pleural perfusion of recombinant human endostain combined with cisplatin on malignant pleural effusion

目的探讨重组人血管内皮抑制素(恩度)联合顺铂灌注治疗恶性胸腔积液的有效性、安全性。方法 60例经细胞学确诊恶性胸水患者随机分成2组,治疗组30例,对照组30例。治疗组胸腔灌注恩度45mg,3次/周(d1,d4,d7),顺铂40mg,3次/周(d2,d5,d8),对照组顺铂同上,24天为1个疗程。1个疗程治疗结束后4周,评价疗效、生活质量及不良反应,治疗组治疗前、治疗后4周酶联免疫吸附实验(ELISA)法进行胸水血管内皮生长因子(VEGF)检测。结果治疗组有效率(24/30,80.0%)高于对照组(16/30,53.3%),差异有统计学意义(P<0.05)。治疗组生活质量改善率(26/30,86.7%)高于对照组(18/30,60.0%),差异有统计学意义(P<0.05)。两组的不良反应差异无统计学意义。治疗组有效患者胸水中VEGF表达治疗后较治疗前明显降低(P<0.01)。结论恩度联合顺铂胸腔灌注是一种安全有效地控制恶性胸水的方法,其作用机制可能与抑制VEGF水平有关。

Objective To observe the efficacy and Safety of pleural perfusion of recombinant human endostain （endostar） combined with cisplatin（DDP） in patients with malignant pleural effusion. Methods Sixty patients with malignant pleural effusion confirmed by cytopathoiogy were randomly divided into two groups.. 30 cases in the treatment group and 30 cases in the control group, Endostar at 45 mg was injected into pleural cavity three times a week （ d1, d4, dT） and DDP at 40 mg was injected into pteural cavity three times a week （ d2, dS, d8） in the treatment group, the same dose of DDP in the control group,and 24 days were one course of treatment. Four weeks after treatment, the therapeutic effects, life quality and toxic side effects were evaluated. Vascular endothelial growth factor iVEGF） of malignant pleural effusion in the treatment group was measured by enzYme-linked immunosorbent assay（ELISA） before treatment and four weeks after treatment. Results The response rates Of the treatment group and the control group were 80.0% and 53.3% ,there was significant difference （ P 〈0.05）. The improvement rates of life Of quality in the treatment group and the control group were 86.7% and 60.0%, there was significant difference （P 〈 0.05）. However,the rates of toxic side effects of the two groups had no significant difference. The level of VEGF of the valid cases in the treatment group was significantly decreased （P 〈 0.01）. Conclusion Pleural perfusion of endostar combined with DDP is an effective and safe treatment method for patients with malignant pleural effusion,which might result from the inhibition of VEGF level.