经导管动脉化疗栓塞术联合冷冻消融治疗不可切除性大肝癌患者的效果及对细胞免疫的影响

Efficacy of transcatheter arterial chemoembolization combined with cryoablation for unresectable large hepatocellular carcinoma and the effect on cellular immunity

目的探讨经导管动脉化疗栓塞术(TACE)联合冷冻消融治疗不可切除性大肝癌患者的疗效及对细胞免疫的影响。方法选取2016年3月至2018年3月间山东省青岛市中心医院收治的62例不可切除性大肝癌患者为研究对象,采用随机数表法分为治疗组和对照组,每组31例。治疗组患者在TACE上联合冷冻消融治疗,对照组患者行TACE治疗。比较两组患者临床疗效、不良反应发生情况及治疗前后T淋巴细胞亚群水平变化。结果治疗组患者的临床疗效总有效率为93. 5%,优于对照组患者的74. 2%,差异有统计学意义(P <0. 05)。治疗组患者的总体不良反应发生率为12. 9%,低于对照组患者的35. 5%,差异有统计学意义(P <0. 05)。治疗前,两组患者的CD3+、CD4+、CD8+、CD4+/CD8+水平比较,差异无统计学意义(P> 0. 05)。治疗后,两组患者的CD3+、CD4+、CD4+/CD8+水平均高于治疗前,且治疗组高于对照组,而两组患者的CD8+水平均低于治疗前,且治疗组低于对照组,差异均有统计学意义(均P <0. 05)。结论 TACE联合冷冻消融治疗不可切除性大肝癌疗效显著,且不良反应发生情况较少,可有效改善患者细胞免疫功能,值得临床推广运用。

Objective To investigate the efficacy of transcatheter arterial chemoembolization(TACE)combined with cryoablation in the treatment of unresectable large hepatocellular carcinoma and its effect on cellular immunity.Methods A total of 62 patients with unresectable large hepatocellular carcinoma who admitted to Qingdao Central Hospital from March 2016 to March 2018 were selected as the research subjects.They were randomly divided into a treatment group and a control group with 31 patients in each group.The treatment group was given TACE plus cryoablation.The patients in the control group were only given TACE.The clinical efficacy,adverse reactions and changes in T lymphocyte subsets before and after treatment were compared between the two groups.Results The overall efficacy rate was 93.5%in the treatment group,which was superior to 74.2%of the control group(P<0.05).The overall incidence of adverse reactions was 12.9%in the treatment group,which was lower than 35.5%of the control group(P<0.05).Before the treatment,there were no significant differences in CD3+,CD4+,CD8+,and CD4+/CD8+levels between the two groups(all P>0.05).After the treatment,the levels of CD3+,CD4+,CD8+,and CD4+/CD8+in the two groups were higher than before the treatment with the treatment group higher than the control group,while the CD8+levels in the two groups were lower than before treatment,with the treatment group lower than the control group(all P<0.05).Conclusion TACE combined with cryoablation is effective in the treatment of unresectable large liver cancer,and the incidence of adverse reactions is less,and it can effectively improve the cellular immune function,which is worthy of clinical application.