重组人血管内皮抑制素联合洛铂治疗肺癌恶性胸腔积液的疗效观察

Efficacy of recombinant human endostatin combined with lobaplatin in the treatment of malignant pleural effusion of lung cancer

目的研究重组人血管内皮抑制素联合洛铂治疗肺癌恶性胸腔积液的疗效。方法回顾性选取2018年1月至2020年12月武汉科技大学附属武昌医院收治的120例肺癌恶性胸腔积液患者为研究对象。根据治疗方法不同将患者分为LBP组(n=60)与LBP+END组(n=60)。LBP组给予单独洛铂胸膜腔内灌注治疗,LBP+END组给予重组人血管内皮抑制素联合洛铂胸膜腔内灌注化疗。观察两组患者疗效,比较两组患者治疗前、治疗后1个月、血管内皮生长因子(VEGF)、基质金属蛋白酶2(MMP-2)、炎症因子[白细胞介素(IL)-6、肿瘤坏死因子α(TNF-α)、γ干扰素(IFN-γ)]、T淋巴细胞水平,并记录不良反应及生存期。结果LBP+END组肺癌恶性胸腔积液患者治疗后有效率为91.67%,均显著高于LBP组(75.00%),差异均有统计学意义(P<0.05)。治疗前,LBP组和LBP+END组患者VEGF、MMP-2、IL-6、TNF-α、IFN-γ、CD3^(+)、CD4^(+)及CD8^(+)比较,差异均无统计学意义(P>0.05);治疗后,LBP+END组患者VEGF、MMP-2、IL-6、TNF-α、IFN-γ分别为(21.79±5.47)ng/L、(12.17±4.62)pg/L、(3.45±1.01)pg/L、(1.61±0.47)pg/L、(1.52±0.57)pg/L,均显著低于LBP组[(32.15±6.24)ng/L、(19.53±5.32)pg/L、(5.64±1.16)pg/L、(2.58±1.01)pg/L、(3.08±0.94)pg/L],CD3+、CD4^(+)及CD8^(+)分别为(54.58±4.61)%、(43.79±3.58)%、(35.67±3.47)%,均显著高于LBP组[(51.24±4.35)%、(40.17±3.41)%、(33.16±3.29)%],差异均有统计学意义(P<0.05)。两组在Ⅲ~Ⅳ级骨髓抑制、Ⅲ~Ⅳ级消化道症状、Ⅲ~Ⅳ级肝功能损伤、心脏反应等并发症发生率方面比较,差异均无统计学意义(P>0.05)。LBP+END组肺癌恶性胸腔积液患者中位生存期为(21.52±6.15)个月,显著高于LBP组[(16.78±5.12)个月],差异有统计学意义(P<0.05)。结论与单用洛铂比较,重组人血管内皮抑制素联合洛铂治疗肺癌恶性胸腔积液患者可显著提高治疗效果,抑制炎症反应及VEGF和MMP-2水平,改善患者免疫功能和预后,具有高效、安全等优点。

Objective To study the efficacy of recombinant human endostatin combined with lobaplatin in the treatment of malignant pleural effusion of lung cancer.Methods A retrospective selection of 120 patients with malignant pleural effusion of lung cancer in Wuchang Hospital Affiliated to Wuhan University of Science and Technology who were diagnosed and treated by undergraduates from January 2018 to December 2019 was selected as the research objects.According to the treatment method,malignant pleural effusion of lung cancer was divided into LBP group(n=60)(lobaplatin intrapleural infusion alone)and LBP+END group(n=60).LBP group was treated with lobaplatin intrapleural infusion alone,LBP+END group was treated with recombinant human endostatin combined with lobaplatin intrapleural infusion chemotherapy.The efficacy of the two groups of patients was observed,vascular endothelial growth factor(VEGF),matrix metalloproteinase-2(MMP-2),inflammatory factor[interleukin(IL)-6,tumor necrosis factorα(TNF-α),γ-interferon(IFN-γ)],T lymphocyte levels before treatment and 1 month after treatment of the two groups of patients were compared,and adverse reactions and survival were observed.Results The effective rate of patients with lung cancer malignant pleural effusion in the LBP+END group was 91.67%,which was significantly higher than that in the LBP group(75.00%),the difference was statistically significant(P<0.05).Before treatment,there was no statistically significant difference in VEGF,MMP-2,IL-6,TNF-α,IFN-γ,CD3^(+),CD4^(+)and CD8^(+)between LBP group and LBP+END group(P>0.05);after treatment,the levels of VEGF,MMP-2,IL-6,TNF-α,IFN-γin the LBP+END group were(21.79±5.47)ng/L,(12.17±4.62)pg/L,(3.45±1.01)pg/L,(1.61±0.47)pg/L,(1.52±0.57)pg/L,respectively,which were significantly lower than those in the LBP group[(32.15±6.24)ng/L,(19.53±5.32)pg/L,(5.64±1.16)pg/L,(2.58±1.01)pg/L,(3.08±0.94)pg/L],CD3^(+),CD4^(+)and CD8^(+)in the LBP+END group were(54.58±4.61)%,(43.79±3.58)%,(35.67±3.47)%,respectively,which were significantly higher than those in the LBP group[(51.24±4.35)%,(40.17±3.41)%,(33.16±3.29)%],the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of complications such as heart reaction and cardiac reaction(P>0.05).The median survival time of lung cancer patients with malignant pleural effusion in the LBP+END group was(21.52±6.15)months,which was significantly higher than that in the LBP group[(16.78±5.12)months],and the difference was statistically significant(P<0.05).Conclusion Compared with the single use of Loplatin,the combination of recombinant human endostatin and loplatin in the treatment of malignant pleural effusion patients with lung cancer can significantly improve the efficacy,inhibit inflammatory reactions and levels of VEGF and MMP-2,improve patient immune function and prognosis,and have the advantages of high efficiency and safety.