褪黑素对中晚期肝癌肝动脉化疗栓塞的协同和保护作用

Co-antitumor effect and hepatic protection of melatonin on advanced primary liver cancer treated by transcatheter arterial chemoembolization

目的 :观察褪黑素 (Mel)对中晚期原发性肝癌患者行肝动脉化疗栓塞 (TACE)的协同抗肿瘤作用及肝功能保护作用。 方法 :140例不能手术的中晚期肝癌患者 ,随机分组 ,TACE组 70例 ;TACE+Mel组 70例 ,在每次 TACE治疗前 7d起开始口服 Mel 2 0 m g/ d,连续 2 1d。结果 :TACE组和 TACE+Mel组患者无完全缓解者 ,部分缓解率 (WHO标准 )分别为 12 .9%和 2 2 .9% (P<0 .0 5 ) ,获 2期切除者分别为 4.3%及 12 .9% (P<0 .0 1) ;0 .5年、1年及 3年生存率 TACE组分别为 80 .0 %、5 4.3%和 11.4% ,TACE+Mel组分别为 10 0 %、6 8.6 %及 2 1.4% ,两组比较差异显著 (P<0 .0 5 )。Mel对 TACE引起的肝功能损害有明显保护和治疗作用 ,可降低 TACE后腹水的发生率。同时 ,Mel可增强 TACE后患者外周血 NK细胞活性及提高CD4/ CD8比值 ,提高外周血 IL - 2含量、降低可溶性白细胞介素 - 2受体 (SIL - 2 R)表达 (P<0 .0 1)。结论 :Mel对 TACE有协同抗肿瘤和肝功能保护作用 ,可防治 TACE术后肝功能的损害 ,增强患者自身免疫保护 ,提高疗效 ,延长患者的生存期 ,增加 2期手术机会。

Objective:To observe the co-antitumor effect and hepatic protection of melatonin on unresectable advanced primary liver cancer treated by transcatheter arterial chemoembolization (TACE). Methods:One hundred and forty patients with unresectable advanced primary liver cancer were divided into 2 groups at random, seventy patients received TACE alone while the other 70 patients were treated by TACE+Mel (20 mg/d at 8:00 P.M orally, 7 d before each TACE and lasted for 21 d). Results: The partly resolution rate of TACE and TACE+Mel were 12.86% and 22.86% respectively( P <0.05). The secondary resectable rate of TACE and TACE+Mel were 4.26% and 12.86% respectively ( P <0.01).The 0.5-year,1-year and 3 year survival rate of TACE group were 80%,54.29% and 11.43% respectively, and those of TACE+Mel were 100%,68.57% and 21.43% respectively ( P <0.05). Mel had significant protection and treatment effect on the liver function damage after TACE. NK activity and the ratio of CD4 to CD8 were raised and IL-2 levels in patients were significantly increased while sIL-2R expression decreased after treated by TACE+Mel, but there was no change in TACE group ( P < 0.01). Conclusion: Mel has definite co-antitumor effect and hepatic protection on advanced primary liver cancer treated by TACE,it can protect liver function against the damage induced by TACE, enhance immunological protection of the patients,and improve the effect of TACE extending survival period of patients and increasing the secondary resectable opportunity.