经导管动脉化疗栓塞术联合静脉注射重组人血管内皮抑制素治疗肝癌45例

Effect of TACE combined with intravenous injection of recombinant human endostatin in the treatment of 45 cases of liver cancer

目的 研究经导管动脉化疗栓塞术(TACE)联合重组人血管内皮抑制素注射液(恩度)对原发性肝癌(简称“肝癌”)病人疗效及血清微小RNA(miR-122、miR-21)、干扰素诱导跨膜蛋白3(IFITM3)水平的影响。方法 选取德阳市人民医院2014年8月至2016年10月期间收治的90例肝癌病人,按照数字随机表法分为对照组和观察组,每组45例。对照组采用腹腔镜肝切除术(LLR)治疗+TACE,观察组在对照组基础上使用恩度,并于术后治疗6周。对比两组病人治疗后的3年复发率、生存率以及中位生存时间,监测治疗前后血清微小RNA、IFITM3水平,以及治疗过程中不良反应情况。结果 随访3年,观察组、对照组分别有13例(28.89%)、23例(51.11%)复发,中位生存时间分别为42.24个月(95%CI:33.47~53.27)、27.63个月(95%CI:22.64~31.83),死亡数分别为15例(33.33%)、25例(55.56%),差异有统计学意义(P<0.05)。治疗后两组病人血清miR-21水平显著降低,而miR-122显著增加,两组血清微小RNA水平差异显著(P<0.05)。治疗后,两组病人血清IFITM3、血管内皮生长因子(VEGF)水平均显著降低,其中观察组病人血清IFITM3、VEGF水平显著低于对照组[(301.35±32.12)ng/L比(472.35±36.25)ng/L、(101.35±10.12)μg/L比(142.35±11.78)μg/L,P<0.05]。观察组不良反应发生率35.56%,与对照组(37.78%)相比差异无统计学意义(P>0.05)。结论 腹腔镜肝癌切除术后采用TACE术联合恩度治疗原发性肝癌病人疗效显著,可显著改善血清微小RNA水平,降低IFITM3和VEGF蛋白水平,从而降低复发率和病死率,提高治疗效果。

Objective To study the effect of transcatheter arterial chemoembolization (TACE) combined with recombinant human endostatin injection (Endu) on patients with liver cancer and its effect on serum microRNA (miR-122,miR-21) and interferon-induced transmembrane protein 3 (IFITM3).Methods Ninety patients with liver cancer who were admitted to Deyang People’s Hospital from August 2014 to October 2016 were selected and assigned into a control group and an observation group according to the random table method,with 45 cases in each group.The control group was treated with laparoscopic hepatectomy (LLR)+TACE,while the observation group was treated with Endostar on the basis of the control group and was treated for 6 weeks after operation.The 3-year recurrence rate,survival rate,median survival time,the level of micro RNA and IFITM3 and adverse reaction were compared between the two groups.Results Follow-up for 3 years,there were 13 cases (28.89%) and 23 cases (51.11%) palindromia in the observation group and the control group,the median survival time was 42.24 months (95%CI:33.47-53.27),27.63 months (95%CI:22.64-31.83),and the number of deaths was 15 cases (33.33%) and 25 cases (55.56%),respectively,with statistical significance (P<0.05).After treatment,the level of miR-21 in the two groups decreased and the level of miR-122 increased significantly,and the serum miRNA levels of the two groups were significantly different (P<0.05).The level of serum IFITM3 and VEGF in both groups decreased significantly after treatment,and the level of serum IFITM3[(301.35±32.12) ng/L vs.(472.35±36.25) ng/L],VEGF[(101.35±10.12)μg/L vs.(142.35±11.78)μg/L]in the observation group was significantly lower than that in the control group (P<0.05).The incidence of adverse reactions in the observation group was 35.56%,and there was no significant difference compared with the control group (37.78%)(P>0.05).Conclusion After laparoscopic liver resection,TACE combined with Endostat in the treatment of patients with primary liver cancer has a significant curative effect.It can significantly improve serum microRNA levels and reduce IFITM3 and VEGF protein levels,thereby reducing the recurrence rate and mortality,and improving the treatment effect.