恶性腹腔积液中内皮细胞的检测及其与临床疗效相关性的初步研究

发布时间：2018-01-09 00:08

  本文关键词：恶性腹腔积液中内皮细胞的检测及其与临床疗效相关性的初步研究　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

  更多相关文章： 内皮细胞 重组人血管内皮抑素 恶性腹腔积液

【摘要】：目的通过观察腹腔内灌注重组人血管内皮抑素联合氟尿嘧啶(5-FU)治疗恶性腹腔积液的临床疗效,检测治疗前后腹腔积液中内皮细胞(Endothelial cells,EC)的变化,从而探讨内皮细胞在恶性腹腔积液治疗中的应用价值。方法选取2013年2月~2014年8月安徽省立医院均有脱落细胞学诊断的晚期肿瘤恶性腹腔积液患者39例(其中胃癌21例、结直肠癌4例、胰腺癌2例、胆囊癌6例、不明原因恶性腹腔积液6例)接受重组人血管内皮抑素联合5-FU腹腔内治疗;所有患者此治疗方案前2个月内未行任何抗肿瘤治疗。39例恶性腹腔积液患者均在充分放液后采用腹腔内注入重组人血管内皮抑素60mg联合氟尿嘧啶(5-FU)1.0g治疗,治疗结束后嘱患者30min内频繁改变体位,尽可能使药物与腹腔各个部位充分接触,每周重复为一周期。完成2个周期后观察恶性腹腔积液治疗疗效、生活质量(QOL)和不良反应;治疗前(基线水平)、治疗2个周期后(第3周期治疗前)通过流式细胞学进行腹腔积液内皮细胞的测定。治疗疗效参照WHO腹腔积液评价标准,生活质量(QOL)参照Karnofsky评分标准,不良反应按照美国国家癌症研究所通用药物毒性反应标准(NCI-CTC4.0版)。结果(1)所有患者接受2个周期重组人血管内皮抑素联合氟尿嘧啶腹腔内治疗后进行评估,39例患者中,完全缓解(CR)1例,部分缓解(PR)16例,稳定(SD)14例,进展(PD)8例。客观有效率(CR+PR)43.6%(17/39);(2)在39例患者中,有21例(53.8%)QOL改善,11例QOL稳定(28.2%),7例(17.9%)QOL下降;(3)39例患者出现3~4级的毒性有10例,包括白细胞下降5.1%(2/39)、血小板下降2.6%(1/39)、贫血5.1%(2/39)、恶心10.3%(4/39)以及腹泻2.6%(1/39),未见其它严重不良反应;(4)恶性腹腔积液内皮细胞临床有效者EC治疗前(0.22±0.06)%,治疗后(0.12±0.08)%,生活质量改善者治疗前(0.19±0.08)%,治疗后(0.13±0.08)%,临床有效者(PR)经治疗后EC下降明显(P=0.005),有统计学意义,临床无效者(SD+PD)治疗前后无统计学差异(P=0.114),生活质量改善者经治疗后EC下降明显(P=0.032),有统计学意义,生活质量无改善者治疗前后无统计学差异(P=0.359)。结论腹腔内应用重组人血管内皮抑素联合氟尿嘧啶治疗恶性腹腔积液有较好的近期疗效,并能改善生活质量,不良反应轻,安全,可行。腹腔积液中内皮细胞(EC)百分比在治疗前后有一定变化,其变化程度对预测疗效有一定的指导意义,值得临床进一步探讨研究。
[Abstract]:Objective To observe the effect of intraperitoneal infusion of recombinant human endostatin combined with fluorouracil (5-FU) clinical curative effect in the treatment of malignant ascites and ascites were detected before and after treatment in endothelial cells (Endothelial cells, EC) changes, so as to explore the application value of endothelial cells in the treatment of malignant ascites. Methods from February 2013 ~2014 year in August 39 advanced cancer malignant ascites patients in Anhui Provincial Hospital were cytology diagnosis cases (including 21 cases of gastric cancer, 4 cases of colorectal cancer, 2 cases of pancreatic cancer, 6 cases of gallbladder carcinoma, unexplained malignant peritoneal effusion 6 cases) treated with recombinant human endostatin combined with 5-FU intraperitoneal; this treatment for all patients within 2 months without any anticancer treatment of.39 patients with malignant ascites were treated with intraperitoneal injection of recombinant human endostatin combined with 60mg fluorouracil in full discharge after 1. (5-FU) 0g treatment, frequent change of position Huanzhe within 30min after the end of treatment, as far as possible to make drugs and abdominal parts of full contact, repeated weekly for a period. To observe the curative effect of malignant peritoneal effusion treatment after the completion of 2 cycles, the quality of life (QOL) and adverse reactions; before treatment (baseline level), 2 cycles of treatment (after third cycles of treatment were measured before) peritoneal effusion of endothelial cells by flow cytometry. The curative effect in the treatment of peritoneal effusion according to WHO evaluation standard, the quality of life (QOL) according to the Karnofsky standard for evaluation of adverse reactions, according to the National Cancer Institute Common Toxicity Criteria (NCI-CTC4.0). Results (1) all patients received treatment 2 cycles of recombinant human endostatin combined with fluorouracil intraperitoneal were evaluated in 39 patients, complete remission (CR) 1 cases, partial remission (PR) 16 cases, stable (SD) in 14 cases, progress (PD) in 8 cases. Effective and objective 鐜，

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