摘要:
目的 观察高频热疗联合重组人血管内皮抑制素、 顺铂腔内化疗治疗恶性胸腔积液(MPE)的临床疗效和安全性.方法 选择贵阳市第一人民医院2014年9月至2016年9月48例MPE患者,采用信封法随机分为观察组和对照组.观察组采用高频热疗联合顺铂、重组人血管内皮抑制素腔内化疗(顺铂60 mg/m2+重组人血管内皮抑制素25~30 mg/m2);对照组采用高频热疗联合单药顺铂腔内化疗(顺铂60 mg/m2),Karnofsky评分≥70分的患者,配合静脉全身化疗,21 d为1个周期,连用2~3个周期.腔内化疗后30 min进行高频热疗,60 min/次,2次/周×3周.以χ2检验评估疗效、生命质量和不良反应,以配对样本t检验评估胸腔积液治疗前后肿瘤标志物的变化.结果 观察组24例中完全缓解(CR)2例,部分缓解(PR)17例,稳定(SD)4例,进展(PD)1例,客观有效(CR+PR)率为79.2%;对照组24例中CR 0例,PR 12例,SD 7例,PD 5例,客观有效率为50.0%,差异有统计学意义(χ2=4.463,P=0.035);观察组生命质量Karnofsky评分治疗后高于对照组,患者临床受益率79.2%比54.2%,两组比较差异无统计学意义(χ2=3.375,P=0.066);观察组不良反应与对照组比较,差异均无统计学意义(均P>0.05).两组患者MPE内肿瘤标志物癌胚抗原(CEA)、糖类抗原125(CA-125)、糖类抗原199(CA-199)、细胞角质蛋白19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)水平治疗后均有所降低,除CYFRA21-1两组差异无统计学意义(P=0.161)外,其余3项指标观察组治疗前后变化均大于对照组,差异均有统计学意义(均P0.05). The tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA-125), carbohydrate antigen 199 (CA-199), cytokeratin 19 fragments (CYFRA21-1) and neuron-specific enolase (NSE) in hydrothorax of the two groups were reduced by the treatment, except for the difference of CYFRA21-1 between the two group was not statistically significant (P= 0.161), the changes of the other 3 indicators in the observation group before and after treatment were greater than those in the control group (all P< 0.05). Conclusions High-frequency diathermic therapy and intra-thoracic chemotherapy with single cisplatin are effective in treating patients with malignant pleural effusion, and is more superior when combined with endostar. Additionally, the combination of the above two drugs has synergistic action and better safety, deserves to be further promoted in clinic.