经导管动脉栓塞化疗联合微波消融术治疗晚期肝细胞癌的临床疗效及对患者免疫功能的影响

Clinical efficacy of transcatheter arterial chemoembolization combined microwave ablation in treatment of patients with advanced hepatocellular carcinoma and its effect on immune function

目的探讨经导管动脉栓塞化疗(TACE)联合微波消融术(MWA)治疗晚期肝细胞癌(HCC)的临床疗效及对患者免疫功能的影响。方法采用随机数字表法将200例晚期HCC患者分为对照组和观察组,每组100例,对照组患者进行TACE治疗,观察组患者进行TACE联合MWA治疗。比较两组患者的临床疗效[客观缓解率(ORR)、疾病控制率(DCR)]、免疫功能指标[CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)]、不良反应发生率、复发率及生存率。结果观察组患者的ORR为58.0%,高于对照组患者的43.0%,差异有统计学意义(P﹤0.05);观察组患者的DCR为82.0%,与对照组患者的78.0%比较,差异无统计学意义(P﹥0.05)。术后1个月,两组患者的CD4^(+)水平及CD4^(+)/CD8^(+)均高于本组术前,CD8^(+)、IgA、IgG、IgM水平均低于本组术前,观察组患者的CD4^(+)水平及CD4^(+)/CD8^(+)均高于对照组,CD8^(+)、IgA、IgG、IgM水平均低于对照组,差异均有统计学意义(P﹤0.05)。两组患者的不良反应总发生率比较,差异无统计学意义(P﹥0.05)。随访6个月,观察组患者的复发率明显低于对照组,生存率明显高于对照组,差异均有统计学意义(P﹤0.01)。结论TACE联合MWA治疗晚期HCC患者具有较好的临床疗效,能够改善患者的免疫功能,降低复发率,提高生存率,且未增加不良反应发生率。

Objective To investigate the clinical efficacy of transcatheter arterial chemoembolization(TACE)combined microwave ablation(MWA)in treatment of patients with advanced hepatocellular carcinoma(HCC)and its effect on immune function.Method A total of 200 patients with advanced HCC were randomly divided into control group(n=100,treated with TACE)and observation group(n=100,treated with TACE combined MWA).The clinical efficacy[objective response rate(ORR),disease control rate(DCR)],immune function indicators[CD4^(+),CD8^(+),CD4^(+)/CD8^(+),immunoglobulin A(IgA),immunoglobulin G(IgG)and immunoglobulin M(IgM)],incidence of adverse reactions,recurrence rate and survival rate were compared between the two groups.Result The ORR of the observation group was higher than that of the control group(58.0%vs 43.0%,P<0.05),there was no significant difference in DCR between observation group and control group(82.0%vs 78.0%,P>0.05).One month after operation,the levels of CD4^(+)and CD4^(+)/CD8^(+)in the two groups were higher and the levels of CD8^(+),IgA,IgG,and IgM in the two groups were lower than those before operation,with higher levels of CD4^(+)and CD4^(+)/CD8^(+)and lower levels of CD8^(+),IgA,IgG,and IgM in the observation group than those in the control group(P<0.05).There was no significant difference in the overall incidence of adverse reactions between the two groups(P>0.05).After 6 months of follow up,the recurrence rate was lower and the survival rate of the observation group was higher than those of the control group(P<0.01).Conclusion TACE combined MWA has a better clinical efficacy in treatment of advanced HCC,which can improve the immune function of patients,reduce the recurrence rate,and improve the survival rate without increasing the incidence of adverse reactions.