羟基喜树碱联合苦参注射液治疗老年肺癌恶性胸腔积液的应用价值

Therapeutic effect of hydroxycamptothecin combined with Kushen injection on malignant pleural effusion in elderly patients with lung cancer

目的研究羟基喜树碱联合苦参注射液治疗老年肺癌恶性胸腔积液的效果,并探讨其作用机制。方法82例确诊为晚期肺癌恶性胸腔积液的老年患者(≥60岁)随机分为2组,其中苦参注射液联合HCPT组(试验组)42例、羟基喜树碱组40例,比较2组患者治疗后症状及胸腔积液量的改变情况,检测外周血淋巴细胞亚群变化,检测胸腔积液生化指标(乳酸脱氢酶、总胆固醇、腺苷脱氨酶)和细胞的增殖细胞核抗原(PCNA)、生存素(Survivin)的mRNA表达水平变化情况。结果治疗后试验组有效率、症状改善率明显高于对照组,试验组胸腔积液量减少比对照组明显;试验组在免疫指标及生化指标方面优于对照组(P<0.05);试验组胸腔积液细胞PCNA、Survivin的mRNA表达水平均比对照组降低明显,差异有统计学意义(P<0.05)。结论羟基喜树碱联合苦参注射液治疗老年肺癌恶性胸腔积液效果良好,同时可有效改善患者的免疫功能,其机制可能与苦参抑制胸腔积液细胞PCNA、Survivin的表达有关。

Objective To observe the therapeutic effect of hydroxycamptothecin （ HCPT） combined with Kushen injection on malignant pleural effusion in elderly patients with lung cancer ,and to explore its action mechanism.Methods Eighty-two patients （≥60 years ） diagnosed as advanced stage lung cancer with malignant pleural effusion were randomly divided into 2 groups,trial group （HCPT combined with Kushen injection , n =42） and control group （HCPT only, n =40）. The therapeutic effects were observed and compared between the two groups , and the levels of LDH , CH, ADA in pleural effusion were detected,and the lymphocyte subsets in peripheral blood and expression of PCNA ,Survivin genes were detected too.Results After treatment ,the effective rate and symptom improving rate in trial group were significantly higher than those in control group （ P〈0.05）,however,pleural effusion volume in trial group was significantly decreased ,as compared with that in control group （ P〈0.05）.Moreover the incidence of adverse reactions in trial group was significantly lower than that in control group （ P〈0.05）,and trial group was superior to control group in the indexes including lymphocyte subsets in peripheral blood and biochemical parameters in pleural effusion （ P〈0.05）.The expression levels PCNA,Survivin mRNA in trial group were significantly lower than those in control group （ P〈0.05）.Conclusion HCPT combined with Kushen injection can get satisfactory therapeutic effect on malignant pleural effusion in elderly patients with advanced stage lung cancer,at the same time,which can obviously improve patient ’ s immunological function,and its action mechanism may be related to the inhibition effect of Kushen injection on the expression of PCNA ,Survivin .