重组人血管内皮抑制素与顺铂交替灌注治疗恶性胸腹腔积液近期疗效观察

Short-term effect of recombinant human endostatin and cisplatin alternating perfusion in treatment of malignant pleural effusion or seroperitoneum

目的探讨重组人血管内皮抑制素与顺铂交替灌注治疗恶性胸、腹腔积液的近期疗效。方法选取2012年2月至2014年2月莆田市第一医院收治的晚期恶性肿瘤伴恶性胸、腹腔积液患者86例,根据治疗方法分为对照组和观察组,每组43例。治疗前所有患者经皮穿刺置管引流胸、腹腔积液,观察组患者给予顺铂60 mg·m-2＋生理盐水40 m L腹腔灌注,第1~3天;重组人血管内皮抑制素60 mg＋生理盐水10 m L腹腔灌注,第1、4、7天;对照组患者仅给予顺铂60 mg·m-2＋生理盐水40 m L腹腔灌注,第1~3天;3周为1个周期。治疗2个周期后评估患者近期疗效及不良反应,比较2组患者功能状态Karnofsky评分和生活质量（QOL）评分,采用酶联免疫吸附试验检测患者积液中白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）水平;门诊随访1 a,记录2组患者的生存率。结果观察组和对照组患者治疗总有效率分别为79.07%（34/43）和51.16%（22/43）,观察组患者治疗总有效率显著高于对照组（P〈0.05）。治疗前2组患者积液中IL-10、TNF-α、IFN-γ水平比较差异均无统计学意义（P〉0.05）;与治疗前比较,治疗后2组患者IL-10水平显著降低,TNF-α、IFN-γ水平显著升高（P〈0.05）;治疗后观察组患者IL-10水平显著低于对照组（P〈0.05）,TNF-α、IFN-γ水平显著高于对照组（P〈0.05）。治疗前2组患者Karnofsky评分、QOL评分比较差异均无统计学意义（P〉0.05）;治疗后2组患者Karnofsky评分、QOL评分均显著高于治疗前（P〈0.05）;治疗后观察组患者Karnofsky评分、QOL评分显著高于对照组（P〈0.05）。观察组和对照组患者1 a生存率分别为55.81%（24/43）和32.56%（14/43）,观察组患者1 a生存率显著高于对照组（P〈0.05）。治疗期间2组患者Ⅱ~Ⅲ级白细胞减少、皮肤灼伤、血小板减少发生率比较差异均无统计学意义（P〉0.05）;观察组患者Ⅱ~Ⅲ级胃肠道反应发生率显著高于对照组（P〈0.05）,但经对症处理后均缓解,未影响临床治疗。结论重组人血管内皮抑制素与顺铂交替灌注治疗恶性胸、腹腔积液近期疗效确切,能够提高患者生活质量。

Objective To investigate the short-term effect of recombinant human endostatin and cisplatin alternating perfusion in treatment of malignant pleural effusion or seroperitoneum. Methods Eighty-six patients with advanced malignant tumors complicated with malignant pleural effusion or seroperitoneum were selected in the First Hospital of Putian City from February 2012 to February 2014. The patients were divided into observation group and control group according to therapeutic method,forty-three patients in each group. All patients were performed with percutaneous catheter drainage of pleural and peritoneal effusion before treatment. The patients in observation group were treated with cisplatin 60 mg·m- 2and normal saline40 m L by intraabdominal perfusion from the 1st day to 3rd day; and the patients in observation group were treated with recombinant human endostatin 60 mg and normal saline 10 m L by intraabdominal perfusion on the 1st,4th and 7th day. The patients in control group were treated with cisplatin 60 mg·m- 2and normal saline 40 m L by intraabdominal perfusion from the 1st day to 3rd day. Three weeks was a treatment cycle. The short-term effect and adverse reaction of patients were evaluated after two treatment cycle. The Karnofsky score of functional status and quality of life（ QOL） score were compared between the two groups. The levels of interleukin-10（ IL-10）,tumor necrosis factor-α（ TNF-α） and interferon-γ（ IFN-γ） in effusion were detected by enzyme linked immunosorbent assay. All the patients were followed up for one year,and the survival rate of the patients in the two groups was recorded. Results The total effective rate in observation group and control group was 79. 07%（ 34 /43）and 51. 16%（ 22 /43）,the total effective rate in observation group was significantly higher than that in control group（ P〈0. 05）. There was no significant difference in the levels of IL-10,TNF-α and IFN-γ in effusion between the two groups before treatment（ P〈0. 05）. Compared with control group,the IL-10 level was significantly decreased（ P〈0. 05）,and the levels of TNF-α and IFN-γ were significantly increased in the two groups after treatment（ P〈0. 05）. After treatment,the level of IL-10 in observation group was significantly lower than that in control group（ P〈0. 05）,the levels of TNF-α and IFN-γ were significantly higher than those in control group（ P〈0. 05）. There was no significant difference in Karnofsky score and QOL score between the two groups before treatment（ P〈0. 05）. The Karnofsky score and QOL score after treatment were significantly higher than those before treatment in the two groups（ P〈0. 05）. The Karnofsky score and QOL score in observation group were significantly higher than those in control groups（ P〈0. 05）. The one-year survival rate in observation group and control group was55. 81%（ 24 /43） and 32. 56%（ 14 /43） respectively,the one-year survival rate in observation group was significantly higher than that in control group（ P〈0. 05）. There was no significant difference in the incidences of grade Ⅱ- Ⅲ leucopenia,skin burn and thrombocytopenia between the two groups during the treatment period（ P〈0. 05）. The incidence of gastrointestinal tract reaction（ grade Ⅱ- Ⅲ） in observation group was significantly higher than that in control group（ P〈0. 05）,but the gastrointestinal tract reaction relieved after symptomatic treatment,and did not affect the clinical treatment. Conclusion Recombinant human endostatin and cisplatin alternating perfusion in treatment of malignant pleural effusion or seroperitoneum can obtain preonunced short-term effect,and can improve the QOL of patients.