重组人血管内皮抑制素联合顺铂治疗肺癌恶性胸腔积液的临床观察

Clinical observation of recombinant human endostatin combined with cisplatin in the treatment of pleural effusion of lung cancer

目的 探讨重组人血管内皮抑制素联合顺铂治疗肺癌恶性胸腔积液的临床疗效观察。方法 选择肺癌恶性胸腔积液患者100例，采用随机数字表法分为观察组和对照组，每组50例。对照组患者采用顺铂40 mg/m2单药胸腔灌注给药治疗，观察组患者在顺铂40 mg/m2基础上给予重组人血管内皮抑制素45 mg治疗，两组患者均每周2次，连续治疗3周。比较两组患者临床疗效、不良反应、治疗前后免疫功能指标、生活质量改善状况。结果 （1）对照组治愈10例，显效24例，有效12例，总有效率92%，观察组治愈4例，显效14例，有效18例，总有效率72%，两组差异有统计学意义（χ2＝9.15，P〈0.05）；（2）对照组恶心呕吐发生15例，白细胞减少发生12例，中性粒细胞减少发生11例，血小板减少发生10例，观察组恶心呕吐发生4例，白细胞减少发生14例，中性粒细胞减少发生10例，血小板减少发生14例，两组差异无统计学意义（χ2＝10.24，P〉0.05），但观察组发生不良反应例数少于对照组，说明观察组安全性高；（3）对照组和观察组治疗前CD4＋细胞分数、CD8＋细胞分数、CD4＋/CD8＋细胞比值差异均无统计学意义（t＝0.03、0.26、0.67，均P〉0.05），治疗后观察组CD4＋细胞分数及CD4＋/CD8＋细胞比值均高于对照组，CD8＋细胞分数低于对照组，差异有统计学意义（t＝11.58、12.36、10.84，P〈0.05）；（4）观察组改善31例，稳定10例，下降9例，对照组改善25例，稳定12例，下降13例，两组差异有统计学意义（χ2＝2.30，P〈0.05）。结论 重组人血管内皮抑制素联合顺铂治疗肺癌恶性胸腔积液的临床疗效显著，能增强患者的免疫功能，有效改善患者的生活质量，且安全性好，不良反应少。

Objective To investigate the clinical effect of recombinant human endostatin combined with cisplatin in the treatment of malignant pleural effusion of lung cancer.Methods 100 lung cancer patients with malignant pleural effusion were selected and divided into observation group and control group according to the random number table method,with 50 cases in each group.The control group was treated with cisplatin 40mg/m2 single-dose pleural perfusion.The observation group was treated with 40mg/m2 of cisplatin on the basis of 45mg of recombinant human endostatin.All the patients were treated twice a week,treatment for 3 weeks.The clinical efficacy,adverse reactions,the immune function indicators before and after treatment,quality of life improvement were compared between the two groups.Results（1）In the control group,10 cases were cured,markedly effective in 24 cases,effective in 12 cases,the total effective rate was 92%.In the observation group,4 cases were cured,markedly effective in 14 cases,effective in 18 cases,the total effective rate was 72%,the difference between the two groups was statistically significant（χ2=9.15,P〈0.05）.（2）In the control group,15 cases occurred nausea and vomiting,12 cases of leukopenia,11 cases of neutropenia,10 cases of thrombocytopenia.In the observation group,4 cases of nausea and vomiting,14 cases of leukopenia,10 cases of neutropenia,14 cases of thrombocytopenia.There was no statistically significant difference between the two groups（χ2=10.24,P〉0.05）,but the number of adverse reactions in the observation group was less than that in the control group,which indicated that the safety of the observation group was high.（3）Before treatment,the CD4＋,CD8＋ and CD4＋/CD8＋ between the two groups had no statistically significant differences（t=0.03,0.26,0.67,all P〉0.05）.After treatment,the percentage of CD4＋ and CD4＋/CD8＋ in the observation group were higher than those in the control group,the percentage of CD8＋in the observation group was lower than that in the control group,the differences were statistically significant（t=11.58,12.36,10.84,all P〈0.05）.（4）In the observation group,improved in 31 cases,stable in 10 cases,decreased in 9 cases.In the control group,improved in 25 cases,stable in 12 cases,decreased in 13 cases.There was in statistically significant difference between the two groups（χ2=2.30,P〈0.05）.Conclusion Recombinant human endostatin combined with cisplatin in the treatment of pleural effusion of lung cancer is significant,which can enhance the immune function of patients,improve the quality of life of patients,and with good safety,less adverse reactions.