贝伐珠单抗联合洛铂腔内灌注治疗老年肺癌恶性胸腔积液的效果

EFFICACY OF INTRAPLEURAL INFUSION OF BEVACIZUMAB AND LOBAPLATIN IN TREATMENT OF ELDERLY LUNG CANCER PATIENTS WITH MALIGNANT PLEURAL EFFUSION

目的探讨贝伐珠单抗联合洛铂腔内灌注治疗老年肺癌恶性胸腔积液的效果及安全性。方法选择2018年6月—2019年12月我科收治的老年肺癌恶性胸腔积液病人58例,随机分为对照组和治疗组,每组29例。对照组经胸腔引流管引流净积液后胸腔灌注洛铂30 mg/m^(2),每周1次;治疗组在灌注洛铂的基础上给予贝伐珠单抗200 mg胸腔灌注,每周1次。比较两组病人的客观疗效、生活质量、不良反应,以及两组治疗前后胸腔积液中血管内皮生长因子(VEGF)水平和红细胞计数变化。结果治疗组和对照组总有效率分别为82.8%、55.17%,两组疗效比较差异具有统计学意义(z=2.051,P<0.05)。治疗组生活质量改善率高于对照组(z=2.219,P<0.05)。两组治疗后VEGF水平、红细胞计数均较治疗前明显降低,且治疗组VEGF水平、红细胞计数治疗前后差值明显高于对照组,差异具有统计学意义(t=6.995、3.901,P<0.05)。不良反应方面,治疗组高血压的发生率高于对照组(z=2.035,P<0.05),但多数为1~2级。结论贝伐珠单抗联合洛铂胸腔灌注治疗老年肺癌恶性胸腔积液效果显著,并可有效降低胸腔积液中VEGF水平,减轻血性胸腔积液,进一步提高生活质量,不良反应可控,值得临床推广应用。

Objective To study the efficacy and safety of intrapleural infusion of bevacizumab and lobaplatin for elderly lung cancer patients with malignant pleural effusion.Methods We selected 58 elderly patients with lung cancer and malignant pleural effusion admitted to our department from June 2018 to December 2019.The patients were randomly divided into control group and treatment group,with 29 cases in each group.The control group received complete drainage of the effusion through a chest drainage tube,followed by intrapleural infusion of lobaplatin at a dose of 30 mg/m^(2) once a week.The treatment group was given intrapleural infusion of 200 mg bevacizumab in addition to intrapleural lobaplatin infusion once a week.Objective efficacy,quality of life,adverse reactions,and changes in vascular endothelial growth factor(VEGF)level and red blood cell count in pleural effusion before and after treatment were compared between the two groups.Results The overall response rate showed a significant difference between the treatment group and the control group(82.8%vs 55.17%,z=2.051,P<0.05).The improvement rate of quality of life in the treatment group was significantly higher than that in the control group(z=2.219,P<0.05).After treatment,VEGF level and red blood cell count in both groups were significantly decreased,and the treatment group had significantly greater reductions in VEGF level and red blood cell count than the control group(t=6.995,3.901;P<0.05).In terms of adverse reactions,hypertension was significantly more frequent in the treatment group than in the control group(z=2.035,P<0.05),but mostly grade 1-2 hypertension.Conclusion Intrapleural infusion of bevacizumab and lobaplatin shows good efficacy in the treatment of elderly lung cancer patients with malignant pleural effusion.The combination therapy can effectively reduce the level of VEGF in pleural effusion,resolve bloody pleural effusion,and improve the quality of life,with controllable adverse reactions,which holds promise for clinical application.