重组人血管内皮抑制素联合顺铂治疗肺癌胸腔积液的临床研究

Study of endostain combined with cisplation in malignant pleural effusion of lung cancer

目的利用重组人血管内皮抑制素（恩度）联合顺铂,进行胸腔灌注治疗肺癌胸腔积液,评估疗效及安全性,初步探讨其机制。方法选取衢州市人民医院2011年1月～2014年12月收治的80例肺癌合并胸腔积液患者,随机分为观察组和对照组,每组各40例。观察组胸腔内注入重组人血管内皮抑制素联合顺铂;对照组胸腔内注入顺铂,2组治疗前后分别进行胸腔积液测定、卡氏功能状态评分（KPS评分）,毒性并测定胸腔积液中血管内皮生长因子（VEGF）水平。结果治疗后,观察组临床疗效有效率（RR）、生活质量改善率及胸腔积液中VEGF下降水平明显高于对照组,差异有统计学意义（P〈0.05）;观察组血性胸腔积液较非血性胸腔积液中VEGF高,差异有统计学意义（P〈0.05）,治疗后两者均可导致VEGF水平的下降,但临床疗效有效率两者之间无统计学意义。结论肺癌合并胸腔积液患者经重组人血管内皮抑制素联合顺铂胸腔注入治疗后临床疗效明显,不良反应低,推测可能与恩度通过抑制VEGF的表达协同顺铂抑制肿瘤的生长和胸腔积液的产生有关,可有效改善患者生活质量延长生命。

Objective To observe the efficacy and safety of pleural perfusion of recombinant human endostain（endostar） combined with cisplatin（DDP） in lung cancer patients with pleural effusion.Methods 80 patients with pleural effusion of lung cancer from January 2011 to December 2014 in our hospital were selected and randomly divided into the treatment group and the control group two groups with 40 cases in each group.Recombinant human endostain and DDP were injected into pleural cavity in the treatment group,the same dose of DDP was injected into the control group.Pleural effusion,KPS,Toxic and the exepress of vascular endothelial growth factor（VEGF） of pleural effusion were measured before and after treatment.Results After treatment,the clinical efficacy of the observation group（RR）,quality of life improvement rate and the level of VEGF in pleural effusion was significantly higher than that in the control group,the difference was statistically significant（P〈0.05）.The level of VEGF in Bloody pleural effusion was higher than in the non-bloody pleural effusion in the treatment group,there was significant difference（P〈0.05）.The observation group was higher than that of non hemorrhagic pleural effusion VEGF,the difference was statistically significant（P〈0.05）,both of them could lead to the decrease of VEGF level after treatmen,but there was no statistical significance between the two groups.Conclusion Clinical efficacy of intrapleural injection of recombinant human endostatin combined with cisplatin in patients with lung cancer complicated with pleural effusion,low adverse reaction,it is speculated that the recombinant human endostatin can inhibit the growth of tumor and the formation of pleural effusion by inhibiting the expression of VEGF in combination with cisplatin,it could effectively improve the quality of life of patients and prolong life。