鸦胆子油乳联合阿帕替尼及替莫唑胺治疗复发性恶性脑胶质瘤

Brucea javanica oil emulsion combined with apatinib and temozolomide in the treatment of recurrent high-grade glioma

目的探讨鸦胆子油乳联合阿帕替尼及替莫唑胺治疗复发性恶性脑胶质瘤患者的临床疗效、免疫功能影响及不良反应。方法选取2016年6月至2018年12月期间郑州大学第一附属医院复发性恶性脑胶质瘤患者52例,随机分为2组,A组26例应用阿帕替尼及替莫唑胺治疗,B组26例应用鸦胆子油乳联合阿帕替尼及替莫唑胺治疗,比较2组临床疗效、免疫功能及不良反应。结果治疗后,B组客观缓解率为69.23%,高于A组的38.46%(P<0.05)。治疗后,A组CD3+T细胞、CD4+辅助性T细胞、CD4+/CD8+较治疗前显著降低(P均<0.05),而B组上述指标较治疗前显著升高(P均<0.05),且均显著高于A组(P<0.05)。治疗后,B组KPS评分高于治疗前,且高于A组(P均<0.05)。B组不良反应发生率低于A组,但差异无统计学意义(P>0.05),且不良反应轻微可耐受,对症处理后消失。B组6个月疾病无进展生存率65.4%、中位疾病无进展生存期7.56个月(95%CI:5.72~9.40个月)、中位总生存期10.14个月(95%CI:8.59~11.70个月),均明显高于A组的46.2%、5.78个月(95%CI:4.64~6.92个月)、8.73个月(95%CI:8.22~9.25个月)(P均<0.05)。结论鸦胆子油乳联合阿帕替尼及替莫唑胺治疗复发性恶性脑胶质瘤可提高近期临床治疗效果,调节患者免疫功能,改善其生活质量和生存,且安全性良好,值得临床应用推广。

Objective To investigate the clinical efficacy,immune function regulation and toxicity of brucea javanica oil emulsion combined with apatinib and temozolomide in the treatment of patients with recurrent high-grade glioma.Methods Fifty-two recurrent malignant glioma patients between June 2016 and December 2018 were randomly assigned to two different groups.Group A had 26 patients,were treated with apatinib and temozolomide.Twenty-six patients in group B were treated with brucea javanica oil emulsion combined with apatinib and temozolomide.The two different group patients were compared with clinical efficacy,immune function changes and toxicity.Results The recent objective remission rate of group B was significantly higher than that of group A,at 69.23%compared to 38.46%(P<0.05).After treatment,CD3+T cells,CD4+helper T cells and CD4+/CD8+were significantly decreased in group A compared with that before treatment(P<0.05),while the above indicators were significantly increased in group B compared with that before treatment(P<0.05),and were all significantly higher than that in group A(P<0.05).KPS score of group B was significantly better than that of group A before treatment(P<0.05).The overall toxicity rate in group B was lower than that in group A,with no statistically significant difference(P>0.05),and the toxicities were mildly toned and disappeared after treatment.The 6 months progression free survival rate was 65.4%,the medium progression free survival was 7.56 months(95%CI:5.72 to 9.40 months)and the medium overall survival was 10.14 months(95%CI:8.59 to 11.70 months)in Group B were significantly higher than 46.2%,5.78 months(95%CI:4.64 to 6.92 months)and 8.73 months(95%CI:8.22 to 9.25 months)in group A(P<0.05).Conclusion For recurrent high-grade glioma,brucea javanica oil emulsion combined with apatinib and temozolomide can improve the recent clinical efficacy,immune function,quality of life and prolong progression-free survival and overall survival.In addition,toxicities are mildly toned and worthy of clinical application.