甘露聚糖肽联合化疗药物腔内灌注治疗恶性浆膜腔积液的临床研究

Clinical Observation of Perfusion with Mannatide and Cytotoxic Drugs in the Treatment of Malignant Effusion

目的：评价甘露聚糖肽联合化疗药物（顺铂和氟尿嘧啶）灌注治疗恶性浆膜腔积液的临床疗效及毒副反应。方法44例恶性浆膜腔积液患者随机分为2组，所有患者均经浆膜腔穿刺置管，充分引流积液后行灌注治疗，治疗组（n=23），灌注甘露聚糖肽40～50 mg，顺铂40～60 mg或者氟尿嘧啶0.5～1.0 g；对照组（n=21），灌注顺铂40～60 mg或者氟尿嘧啶0.5～1.0 g。48 h后开放引流管，保持引流通畅，每周1次，连用2周。结果治疗组有效率（RR）和疾病控制率（DCR）分别为47.8%（11/23）和73.9%（17/23），优于对照组的38.1%（8/21）和66.7%（14/21），但差异无统计学意义（P＞0.05）。治疗组KPS评分好转率明显优于对照组，差异有统计学意义（P＜0.05）。2组不良反应以1～2级为主，主要有骨髓抑制、消化道反应及局部疼痛。3～4级不良反应少见，治疗组乏力和周围神经毒性明显优于对照组（P＜0.05）。结论甘露聚糖肽联合化疗药物治疗恶性浆膜腔积液有一定疗效，能明显改善肿瘤患者的生活质量，不良反应轻，值得临床广泛应用。

Objective To evaluate the clinical effi cacy and adverse reactions of perfusion with mannatide plus cytotoxic drugs （cisplatin and fluorouracil） in treatment of malignant effusion.Methods 44 patients with malignant effusion were randomly divided into two groups. All patients underwent serous cavity puncturation, continuously draining the effusion via central venous catheter. Then 23 cases in treatment group were treated with mannatide （40~50 mg） plus cisplatin （40~60 mg） orfl uorouracil （0.5~1.0 g） through the central venous catheter; 21 cases in control group only received cisplatin （40~60 mg） orfl uorouracil （0.5~1.0 g）. The treatment for two groups was repeated once per week and continued for 2 weeks.Results The response rate and the disease control rate of the treatment group were 47.8% （11/23） and 73.9% （17/23）, better than 38.1% （8/21） and 66.7% （14/21） of the control group, but there was no signifi cant statistic difference between the two groups （P〉0.05）. Life quality improvement rate of the treatment group was still better than the control group （P〈0.05）. The main side effect of two groups were myelosuppression, gastrointestinal reaction and regional pain.Conclusion Perfusion of mannatide plus cytotoxic drugs to treat malignant effusion is a certain effective and hypotoxic therapy, and can also improve the life quality of patients.