胶质瘤次全切除术后不同激素治疗瘤周水肿的临床分析

Clinical control trial of different hormone for intracranial tumor edema after subtotal resection of gliomas

目的评价胶质瘤次全切除后给予甲泼尼龙治疗瘤周水肿的临床疗效及安全性。方法收集2015年6月至2016年1月95例胶质瘤次全切除病例,随机分为甲泼尼龙组(n=32)、地塞米松组(n=33)及对照组(n=30),术后前两组分别给予等效剂量的甲泼尼龙40 mg/次和地塞米松10 mg/次,每天2次静脉治疗(上午8:00、下午4:00),对照组仅应用脱水治疗。根据《颅内肿瘤周围水肿药物治疗专家共识(第1版)》,采用头颅MRI测算3组术后72 h、5 d、14 d、28 d的水肿指数(EI)。观察治疗过程中各组的不良反应情况。结果对于胶质瘤次全切除术后瘤周水肿,在术后3~7天水肿产生高峰期,甲泼尼龙组术后5天的EI较地塞米松组减少,差异无统计学意义(P>0.05);甲泼尼龙组和地塞米松组术后14天的EI分别为2.58±1.02和3.67±1.71,差异有统计学意义(P=0.023),两组术后28天的EI分别为1.76±0.72和2.14±1.13,差异有统计学意义(P=0.01)。地塞米松对内环境的影响和甲泼尼龙引起的消化道应激性反应各有劣势。结论对于控制胶质瘤次全切除术后瘤周水肿,甲泼尼龙较地塞米松更有优势,但应积极预防激素本身引起的不良反应。

Objective To evaluate the clinical efficacy and safety of methylprednisolone for the treatment of peritumoral ede- ma after glioma subtotal resection. Methods From Jun 2015 to Jan 2016, a total of 95 cases of glioma which underwent subtotal resec- tion were selected and randomly divided into methylprednisolone group（ n= 32）, dexamethasone group（ n= 33） and control group（ n= 30）. After operation, methylprednisolone and dexamethasone groups were treated with equivalent dose of methylprodnisolone 40 mg and dexamethasone 10 mg and twice a day at 8：00 and 16：00. The control group was only applied with dehydration treatment. Based on consensus on the drug treatment of peritumoral brain edema （ 1~t edition）, the edema index （El） values of each group were respectively tested by MRI at the different time points including 72 hours, 5 days, 14 days and 28 days after subtotal resection. The adverse reac- tions of these 3 groups were monitored during the treatment. Results During the peak period of edema which appeared from the 34 to 7th days, although methylprednisolone was more effective to control the peritumoral edema comparing with dexamethasone, there was no obvious statistical difference （ P〉0. 05 ）. After 14 days, the El values of methylprednisolone group and dexamethasone group were 2. 58 ±1.02 and 3.67±1.71 respectively, and the difference was statistically significant （P=0. 023）. On the 28th day, the E1 values were 1.76±0. 72 and 2. 14±1.13 respectively, and difference was statistically significant （P= 0. 01 ）. Both of these two groups had their own defect due to the adverse drugs reactions, dexamethasone could influence the internal environment and the methylprednisolone would cause gastrointestinal stress response. Conclusion With equivalent dose, methylprednisonone is more efficient to control peritumoral edema after subtotal resection of gliomas than dexamethasone. Furthermore, adverse reactions during the treatment should be actively prevented.