摘要
目的比较重组人血管内皮抑素(rh-ES)联合经导管肝动脉化疗栓塞(TACE)与单纯TACE治疗中晚期原发性肝癌(PHC)的临床疗效。方法中晚期PHC患者85例行TACE治疗,根据TACE前后是否应用rh-ES注射液分为观察组(45例)、对照组(40例),对比2组TACE术后近期疗效、血清标志物[甲胎蛋白(AFP)、胰岛素样生长因子Ⅱ(IGF-Ⅱ)、胰岛素样生长因子结合蛋白-2(TGFBP-2)、血管内皮生长因子(VEGF)]水平及化疗期间药物不良反应,随访观察2组患者生存时间。结果观察组总体有效率为20.0%,临床获益率为88.9%,均高于对照组的12.5%、80.0%,差异均无统计学意义(x^2=0.866、1.292,P>0.05)。与术前比较,2组TACE术后2个月,患者血清AFP、IGF-Ⅱ、IGFBP-2、VEGF水平均明显下降(t_观=20.658、12.453、14.597、21.797,t_对=15.374、7.950、10.968、11.091,P<0.05);观察组治疗后上述指标水平均显著低于对照组,差异有统计学意义(t=2.870、8.123、2.714、6.994,P<0.05)。2组骨髓抑制、胃肠道反应、肝功能损害、发热等常见毒性反应发生率无明显差异(P>0.05),观察组注射rh-ES后心律失常发生率(11.1%)高于对照组(2.5%),差异无统计学意义(P>0.05)。观察组和对照组TACE术后中位生存时间分别为(21.0±1.1)个月、(15.0±1.3)个月,2组生存时间比较差异有统计学意义(x^2=4.227,P=0.040)。观察组TACE术后12个月生存率为80.0%、24个月生存率为42.2%均高于对照组的67.5%、27.5%,但差异均无统计学意义(x^2=1.725,P=0.189;x^2=2.010,P=0.156)。结论 TACE基础上联合应用rh-ES治疗中晚期PHC,能抑制肿瘤血管的生成,提高近期疗效与远期生存时间;rh-ES使用过程中要注意对心血管系统的毒性作用。
Objective To compare the clinical curative effect of recombinant human endostatin ( rh-ES) combined with transcatheter arterial chemoembolization ( TACE) and single TACE in the treatment of advanced primary hepatocellular carcinoma(PHC).Methods 85 cases of advanced PHC patients underwent TACE treatment.According to whether applied the injection of rh-ES before and after TACE, they were divided into observation group (45 cases), control group (40 cases). Two groups’ TACE postoperative curative effect in the near future were compared , serum marker [alpha fetal protein (AFP), insulin like growth factor II (IGF-II) , insulin like growth factor binding protein 2 (TGFBP-2), vascular endothelial growth factor ( VEGF) ] and chemotherapy drug adverse reaction were compared between the two groups. All patients were followed up for survival time .Results Observation group ’ s overall efficiency was 20.0%, and clinical benefit rate was 88.9%, which was higher than the 12.5% and 80.0% in the control group, the difference was not statistically significant (χ2 =0.866,χ2 =1.292, P &gt;0.05).Compared with the preoperative, 2 months after TACE operation, serum AFP, IGF-II, IG-FBP 2 and VEGF levels were significantly decreased in both of the two groups (observation group:t =20.658, t =12.453, t=14.597, t =21.797, control group:t =15.374, t =7.950, t =10.968, t =11.091, P 〈0.05);after treatment, obser-vation group ’ s indexes level were significantly lower than those of the control group , the difference were statistically significant ( t =2.870, t =8.123, t =2.714, t =6.994, P 〈0.05).Two groups’ bone marrow suppression, gastrointestinal tract reaction, liver function damage, fever and other common toxicity reaction rate had no significant difference ( P〉0.05), the observation group after injected rh-ES’ s arrhythmia occurred rate was 11.1%, which was higher than that of the control group’s 2.5%, the difference was not statistically significant ( P 〉0.05).The observation group and the control group after TACE’s median follow-up time was(21.0 ±1.1) months and (15.0 ±1.3) months, the difference in survival time between the two groups has statistical significance (χ2 =4.227, P =0.040).In the observation group, TACE postoperative 12 months’ survival rate was 80.0%, 24 months’ survival rate was 42.2%, which were higher than those of control group ’ s 67.5%and 27.5%, but the differences were no statistical significance (χ2 =1.725, P =0.189;χ2 =2.010, P =0.156). Conclusion Transcatheter arterial chemoembolization ( TACE) combined application of rh-ES in the treatment of advanced PHC can inhibit the formation of tumor blood vessels , improve the short-term effects and long-term survival time;toxic effects on the cardiovascular system should be noticed during using rh-ES.
出处
《疑难病杂志》
CAS
2015年第9期939-943,共5页
Chinese Journal of Difficult and Complicated Cases
关键词
原发性肝癌
重组人血管内皮抑素
经导管肝动脉化疗栓塞
甲胎蛋白
血管内皮生长因子
生存时间
Primary hepatocellular carcinoma
Recombinant human endostatin
Transcatheter arterial chemoemboliza-tion
Alpha fetoprotein
Vascular endothelial growth factor
Survival time