rhu-TNF腔内治疗恶性胸腔积液的疗效与可能机制探讨

Efficacy of Malignant Pleural Effusion Treated by Intrapleural Perfusion with Recombinant Human Mutant Tumor Necrosis Factor and Its Possible Mechanism

[目的]研究注射用重组人改构肿瘤坏死因子（rhu-TNF）腔内注射治疗恶性胸腔积液的疗效并探讨其可能机制。[方法]将60例恶性胸腔积液患者随机分为对照组（29例）和观察组（31例）,对照组给予顺铂（DDP）治疗,观察组在对照组基础上给予rhu-TNF。收集并对比治疗前后各组胸水的Bcl-2 m RNA和Bax m RNA表达,以及治疗后的疗效（RR）、临床获益反应（CBR）、不良反应、疾病进展时间（TTP）。[结果 ]治疗前,两组Bcl-2 m RNA和Bax m RNA的表达无显著差异（P〉0.05）,治疗后,两组Bcl-2 m RNA均降低（P〈0.05）,Bax m RNA的表达增高（P〈0.05）;与对照组比,观察组的Bcl-2 m RNA明显降低（P〈0.05）,Bax m RNA的表达明显增高（P〈0.05）。对照组RR、CBR分别为41.38%和48.28%,观察组RR、CBR分别为70.97%和77.41%,两组间差异有统计学意义（P〈0.05）。随访3-12个月,对照组TTP为5.1个月,观察组TTP为7.1个月,差异有统计学意义（P〈0.05）。两组不良反应无显著差异。[结论 ]rhu-TNF治疗恶性胸腔积液的机理之一在于降低胸腔脱落细胞Bcl-2表达,升高Bax表达,促进肿瘤细胞凋亡,且无明显的不良反应。

[Objective] To explore the clinical effect and the possible mechanism of recombinant human mutant tumor necrosis factor（rhu-TNF） in the treatment of malignant pleural effusion.[Methods] 60 cases with malignant pleural effusion were randomly divided into 2 groups,29 cases in control group who accepted cisplatin（DDP） and 31 cases in observation group who accepted DDP combined with rhu-TNF.Bcl-2 m RNA and Bax m RNA were detected before and after treatment.The effective rate,responding time and adverse reaction were observed in 2 groups after treatment.[Results] Before treatment,Bcl-2 m RNA and Bax m RNA expression had no significant difference in 2 groups.After treatment,expression of Bcl-2 m RNA decreased,expression of Bax m RNA increased in 2 groups.Compared with the control group,expression of Bcl-2 m RNA decreased,expression of Bax m RNA increased in the observation group significantly（P 0.05）.The RR and CBR were 41.38% and 48.28% in control group,while 70.97% and 77.41% in observation group,respectively.TTP were 5.1 and 7.1 months in the control group and the observation group,respectively.Compared with the control group,the RR,CBR and TTP increased in the observation group significantly（P〈0.05）.[Conclusion] The rhu-TNF is a valid option for the treatment of malignant pleural effusion by decreasing Bcl-2 expression and increasing Bax expression,with a good tolerability.