斑蝥酸钠维生素B6注射液联合不同化疗药物对晚期肝癌患者RBM38、SPATS2及预后的影响

Effects of sodium cantharidate vitamin B6 injection combined with different chemotherapeutic drugs on rbm38,spats2 and prognosis in patients with advanced liver cancer

目的:观察斑蝥酸钠维生素B6注射液联合不同化疗药物对晚期肝癌患者RBM38、丝氨酸精子发生相关蛋白2(SPATS2)及预后的影响。方法:将64例晚期肝癌患者随机分成治疗组和对照组。治疗组患者予斑蝥酸钠维生素B6+OXA+5-Fu,对照组患者予OXA+5-Fu化疗。比较两组患者用药后血清中RBM38、SPATS2、AFP含量及临床表现、肝功能、药物毒性反应、生活质量改变情况及生存时间。同时根据实体瘤进行疗效评价。结果:治疗组患者缓解率高于对照组;其血清中SPATS2、AFP表达水平比对照组降低,RBM38、WBC表达升高,差异有统计学意义(均P<0.05);治疗组患者肝功能、生活质量和体力状况较对照组提高,临床症状也较对照组明显改善,差异均具有统计学意义(P<0.05);RBM38与凝血酶原、总胆红素、腹水、肝性脑病、乏力、食欲不振、腹胀、AFP、呈显著负相关(P<0.05),SPATS2与上述指标呈显著正相关(P<0.05);RBM38与白蛋白、白细胞、血钾具有显著正相关(P<0.05),SPATS2与上述指标呈显著负相关(P<0.05);RBM38与SPATS2呈显著负相关(P<0.05);治疗组患者18个月内总有效率为68.75%,24个月生存率50%远高于对照组的33.33%和6.67%;Kaplan-Meier分析显示,RBM38和SPATS2是晚期肝癌患者的预后因素,RBM38阳性表达越高,患者预后越好,风险比为2.385,95%置信区间1.618~4.016,χ^(2)=15.425,P<0.05。SPATS2阳性表达越高,患者预后越差,风险比为2.619,95%置信区间1.408~3.744,χ^(2)=19.73,P<0.05。结论:斑蝥酸钠维生素B6注射液联合5-Fu+OXA可明显延长晚期肝癌患者生存时间,提高远期生存率和生活质量,改善肝功能,药物毒副反应小,晚期肝癌患者SPATS2、RBM38表达水平联合预测RBM38和SPATS2对晚期肝癌患者预后具有重要价值。

Objective:To observe the effects of sodium cantharidate and vitamin B6 injection combined with different chemotherapeutic drugs on RBM38,SPATS2,and prognosis in patients with advanced liver cancer.Methods:A total of 64 patients with liver cancer was ran-domly divided into two groups:the treatment group and control group.The treatment group was treated with sodium cantharidate,vitamin B6+OXA+5-Fu,and the control group was treated with OXA+5-Fu chemotherapy.The levels of rbm38,spats2,and AFP in serum,clinical manifestations,liver function,drug toxicity,changes in quality of life,and survival time were compared between the two groups.At the same time,the therapeutic effect was evaluated according to the solid tumor.Results:The remission rate and progression rate in the treatment group were higher than those in the control group.Compared with the control group,the expression levels of SPATS2 and AFP were de-creased,while the expression levels of RBM38 and WBC were increased in the treatment group,with statistical significance (P<0.05).The clinical manifestations,liver function,drug toxicity,quality of life,and survival time of the treatment group were improved compared with the control group,and the differences were statistically significant (P<0.05).The therapeutic effect of the treatment group was improved com-pared with the control group,and the difference was statistically significant (P<0.05).The RBM38 was significantly negatively correlated with prothrombin,total bilirubin,ascites,hepatic encephalopathy,fatigue,anorexia,abdominal distension,and AFP (P<0.05),while SPATS2 was significantly positively correlated with the above indexes (P<0.05).The RBM38 is associated with albumin and leukocyte.The serum potassium was significantly positively correlated (P<0.05),and SPATS2 was significantly negatively correlated with the above indexes (P<0.05).There was a significant negative correlation between RBM38 and SPATS2 (P<0.05).The short-term overall effective rate in the treatment group was 68.75%at 18 months,and the 24-month survival rate was 29.3%,which was much higher than 33.33%and 6.67%in the control group,Kaplan-meier analysis showed that RBM38 and SPATS2 were prognostic factors for patients with advanced HCC.The higher the positive expression of rbm38,the better the prognosis.The risk ratio was 2.385,95%confidence interval was 1.618~4.016,χ^(2)=15.425,P<0.05.The higher the positive expression of spats2,the worse the prognosis.The risk ratio was 2.619,95%confi-dence interval was 1.408-3.744,χ^(2)=19.73,P<0.05.Conclusion:Sodium cantharidate vitamin B6 injection combined with 5-Fu+oxa can significantly improve the survival time,long-term survival trend,quality of life,liver function and drug toxicity,and side effects of patients with advanced liver cancer.It can affect the expression levels of spats2 and rbm38 in patients with advanced liver cancer,Rbm38 and spats2have important value in predicting the prognosis of patients with advanced liver cancer.