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肝转移癌化疗联合沙利度胺治疗临床疗效与不良反应观察

Clinical observation of chemotherapy combined with thalidomide fortreatment of metastatic hepatic carcinoma
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摘要 目的沙利度胺是一种人工合成的谷氨酸衍生物,具有抗血管生成及免疫调节作用.本研究旨在观察沙利度胺在肝转移癌中疗效及不良反应,评估其抗血管生成作用.方法收集2014-01-01-2016-12-31扬州大学附属医院(28例)及扬州市中医院(12例)病理确诊的肝转移癌患者40例,根据治疗方式分为单纯化疗组19例和沙利度胺联合化疗组21例,治疗2个周期和4个周期后评价疗效,采用超声造影评估肝转移瘤的血管参数上升时间(RT)、达峰时间(TTP)、平均渡越时间(MTT)及峰值强度(PI),酶联免疫法(methods enzyme-linked immunosorbent assay,ELISA)检测外周血肿瘤坏死因子α(tumor necrosis factor,TNF-α)、血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)、碱性成纤维细胞生长因子(basic fibroblas tgrowth factor,bFGF)水平.结果沙利度胺联合化疗组可提高肝转移癌患者总有效率,2组总有效率(overall response rate,ORR)分别为88.0%和68.4%.超声造影提示治疗后 RT、TTP和 MTT延长,PI缩短.治疗2个周期后沙利度胺联合化疗组和单纯化疗组 RT 分别为(18.59±3.28)和(16.98±4.29)s,TTP分别为(29.85±4.45)和(25.66±4.29)s,MTT分别为(108.82±15.28)和(101.18±18.62)s,PI分别为107.38±34.68和113.26±33.12.治疗4个周期后2组 RT 分别为(22.39±4.12)和(20.28±4.43)s、TTP分别为(34.25±5.14)和(32.66±4.29)s、MTT分别为(119.18±13.26)和(112.82±17.42)s,PI分别为99.43±32.64和103.12±30.72.与单纯化疗组相比,沙利度胺联合化疗组2、4个周期 RT、TTP、MTT和PI对比差异有统计学意义.治疗后外周血TNF-α、VEGF及bFGF水平均下降.2个周期后外周血TNF-α水平分别为(318.54±107.35)和(340.13±108.28)ng/L、VEGF水平分别为(130.64±30.48)和(140.12±34.29)pg/mL、bFGF水平分别为(20.45±4.39)和(25.29±4.27)pg/mL,治疗4个周期后外周血 TNF-α水平分别为(268.19±89.27)和(287.38±90.48)ng/L,VEGF水平分别为(268.19±89.27)和(287.38±90.48)pg/mL,bFGF水平分� OBJECTIVE To investigate the efficiency and toxcity of thalidomide in metastatic hepatic carcinoma and to assess its anti-angiogenesis effects.METHODS The patients with metastatic hepatic carcinoma between 2014.01.01-2016.12.31 from The Affliated Hospital of Yangzhou University and Yangzhou Hospital of Traditional Chinese Medicine were collected and divided into two groups,one was chemotherapy alone,the other was thalidomide combined with chemotherapy.After treated for two and four cycles,we used contrast-enhanced ultrasonography(CEUS)to evaluate the vessel parameter of the liver metastasis.ELISA was applied to detect the level of TNF-α,VEGF,bFGF in the peripheral blood.RESULTS Thalidomide promoted the efficiency of patients.The ORR was 88.0%and 68.4%respectively with statistical significance(P<0.05).According to CEUS,after treated for two cycles,in the thalidomide combined with chemotherapy group and chemotherapy lonely group,RT was(18.59±3.28)and(16.98±4.29)s,TTP was(29.85±4.45)and(25.66±4.29)s,MTT was(108.82±15.28)and(101.18±18.62)s,while PI was(107.38±34.68)and(113.26±33.12)respectively.After treated for four cycles,in the thalidomide combined with chemotherapy group and chemotherapy lonely group,RT was(22.39±4.12)and(20.28±4.43)s,TTP was(34.25±5.14)and(32.66±4.29)s,MTT was(119.18±13.26)and(112.82±17.42)s,PI was(99.43±32.64)and(103.12±30.72),respectively.Compared with the chemotherapy group,RT,TTP,MTT,PI all had obvious statistical significance after being treated with two and four cycles.Meanwhile,the level of TNF-α,VEGF,bFGF in the peripheral blood were cut down.After treated for two cycles,TNF-αin two groups was(318.54±107.35)and(340.13±108.28)ng/L,VEGF was(130.64±30.48)and(140.12±34.29)pg/ml,bFGF was(20.45±4.39)and(25.29±4.27)pg/ml,respectively.After treated for four cycles,in the two groups TNF-αwas(268.19±89.27)and(287.38±90.48)ng/L,VEGF was(268.19±89.27)and(287.38±90.48)pg/ml,bFGF was(10.39±2.18)and(13.27±2.67)pg/ml,respectively.Compared with the chemotherapy group,the l
作者 毛海燕 刘斯平 汪竹 徐永成 韩芳 卜平 MAO Hai-yan;LIU Si-ping;WANG Zhu;XU Yong-cheng;HAN fang;BO Ping(Department of Oncology,The Affliated Hospital of Yangzhou University,Yangzhou 225000,P.R.China;Department of Medical Imaging,Yangzhou Hospital of Traditional Chinese Medicine,Yangzhou 225001,P.R.China;Medical College of Yangzhou University,Yangzhou 225009,P.R.China)
出处 《中华肿瘤防治杂志》 CAS 北大核心 2019年第8期559-564,共6页 Chinese Journal of Cancer Prevention and Treatment
基金 扬州市科技局项目(YZ2015067).
关键词 沙利度胺 肝转移癌 抗血管生成 不良反应 thalidomide metastatic hepatic carcinoma anti-angiogenesis untoward effect
作者简介 第一作者:毛海燕,女,江苏盐城人,硕士,副主任医师,主要从事消化道肿瘤的中西医结合治疗研究工作.Tel:86-514-82981199,E-mail:mysea001@163.com;通讯作者:卜平,男,江苏泰兴人,博士,主任医师,教授,主要从事消化道肿瘤中西医结合治疗的研究工作.E-mail:boping@yzu.edu.cn.
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