胸腔热灌注治疗恶性胸腔积液疗效观察

Curative effect of intrapleural hyperthermic perfusion on malignant pleural effusion patients

目的探讨胸腔热灌注治疗恶性胸腔积液（MPE）的疗效。方法选择新乡医学院第一附属医院2012年1月至2013年12月肺癌合并MPE患者60例，随机分为对照组29例和研究组31例。对照组患者给予胸腔闭式引流，引流结束后胸腔内注入顺铂50mg·m^-2；研究组患者给予胸腔热灌注治疗，即45℃生理盐水2500～7000mL胸腔闭式引流循环灌注，再以加热的灭菌蒸馏水600mL＋顺铂50mg·m^-2循环加热灌注胸腔。比较2组患者的治疗效果及生活质量评分。酶联免疫吸附试验检测2组患者外周血干扰素-γ（IFN-1）和白细胞介素-4（IL-4）水平。并观察比较2组不良反应发生情况。结果研究组完全缓解（CR）15例，部分缓解（PR）11例，稳定（SD）5例，有效率为83．9％；对照组CR10例，PR8例，SD10例，进展（PD）1例，有效率为62．1％；研究组患者治疗有效率显著高于对照组（P〈0．01）。研究组和对照组治疗后Kamofsky评分分别为88．6±21．5和62．7±19．8，其差异有统计学意义（P〈0．05）。与治疗前比较，2组治疗后外周血INF-1水平均显著升高，IL-4水平显著降低（P〈0．05）。与对照组治疗后比较，研究组治疗后外周血INF-7水平显著升高，IL-4水平显著降低（P〈0．05）。对照组发生轻度反应7例（24．1％），研究组发生轻度反应10例（32．2％），给予对症治疗后均缓解；2组不良反应发生率差异无统计学意义（P〉0．05）。结论胸腔热灌注治疗MPE疗效显著，且能够较显著改善患者生活质量，纠正了Th1／Th2细胞因子的失平衡状态，且不良反应轻微。

Objective To investigate the curative effect of intrapleural hyperthermic perfusion on patients with malig- nant pleural effusion（MPE）. Methods A total of 60 cases of lung carcinoma patients with MPE were selected and were divid- ed into control group（ n = 29 ） and study group（ n = 60 ）. The patients in control group were given closed drainage of pleural cavity and cisplatin was injected with 50 mg· m^-2 in the cavitas thoracis after drainage ,while the patients in study group were given intrapleural hyperthermic perfusion with 2 500 - 7 000 mL of 45 ℃ physiological saline and 600 mL of heated sterile pu- rified water plus cisplatin 50 mg · m ^-2 by closed drainage of pleural cavity circumfusion. The curative effect and the Karnofsky score（KPS） were judged and compared between the two groups. The enzyme linked immunosorbent assay was used to detect the peripheral blood levels of interferon-γ（IFN-γ） and interleukin4 （IL-4）. And the untoward reaction of the two groups was observed and compared. Results There were 15 cases of complete remission（ CR）, 11 cases of partial remission（PR） ,5 cases of stable disease（SD） ,0 case of progressive disease（PD） in study group,and the effective rate was 83.9%. While there were 10 cases of CR,8 cases of PR, 10 cases of SD, 1 case of PD in control group, and the effective rate was 62.1%. The effective rate in the study group was significant higher than that in the control group（ P 〈 0.01 ）. The Karnofsky score in study group was significantly higher than that in the control group（ P 〈 0.05 ）. Compared with before treatment, the INF-γ level in peripheral blood increased significantly while the IL-4 level in peripheral blood decreased significantly after treatment in the two group （ P 〈 0.05 ）. The INF-γ level in peripheral blood increased significantly while the IL4 level in peripheral blood decreased sig- nificantly after treatment in the study group compared with those in the control group（ P 〈 0.05 ）. Seven cases（ 24. 1% ）in the control group and 10 eases （32.2%） in the study group had mild untoward reaction, which all released after symptomatic treat- ment. There was no significant difference of untoward reaction incidence rate between the two groups. Conclusion It has evi-dent effect of intrapleural hyperthermic perfusion treatment on MPE,which can improve the life quality of patients and correct the imbalanced state of ThlfTh2 cytokine with little untoward reaction.