恩度联合热灌注化疗对卵巢癌恶性腹水中CECs及VCEC的影响

发布时间：2018-03-24 10:45

本文选题：循环内皮细胞　切入点：腹腔热灌注化疗　出处：《河北大学》2017年硕士论文

【摘要】：目的:卵巢癌发病率在全世界女性肿瘤发病中处在第8位,美国公布的数据约有40%的患者可以获得治愈,是女性妇科肿瘤相关死亡率最高的因素。但在我国大部分的患者初治时已属于Ⅲ期,预后欠佳。目前推荐的治疗是肿瘤减灭术及腹腔热灌注化疗,但此种治疗风险较大。循环内皮细胞(CECs)及活化循环内皮细胞(VCEC)是存在于外周血中的内皮细胞的一种,有实验表明其随肿瘤的进展升高,随有效的治疗下降,是预测肿瘤效果及预后的一个可观测的指标。本实验是通过检测外周血中CECs及VCEC数目评价单纯卵巢热灌注化疗及联合恩度腹腔内热灌注化疗的效果及其相关性。方法:应用随机方法将39例患者分为两组,治疗组20例联合恩度进行腹腔热灌注化疗,对照组19例应用单纯腹腔热灌注化疗。在治疗前及治疗后1周抽取外周血应用流式细胞术检测循环内皮细胞(CECs)及活化循环内皮细胞(VCEC)。另外于体检中心抽取健康女性外周血作为阴性对照。观察:1)对照组治疗前、治疗组治疗前及健康人群CECs及VCEC指标及差别;2)对照组与治疗组治疗后CECs及VCEC指标及差别;3)治疗组中血性腹水及普通黄绿色腹水治疗前后CECs及VCEC差别;4)对照组及治疗组抗肿瘤治疗疗效及其差异。所有的统计数据及图表制作均应用SPSS 16.0及EXCEL 2010制作;所有的数据选择表示;所有的统计分析均为双侧分析,其中P0.05具有统计学意义;相关计量数据符合正态分布的采用t检验对比,有效率的对比采用卡方检验,采用spearman‘s进行相关性分析。结果:1.治疗前健康组CECs和对照组有明显差异(p0.001),治疗前健康组CECs结果和治疗组有明显差异(p0.001);治疗组和对照组差异无统计学意义(p=0.658)。治疗前健康组v CEC和对照组有明显差异(p0.001),治疗前健康组v CEC与治疗组有明显差异(p0.001),治疗组和对照组无显著差异(p=0.726)。2.对照组治疗前CECs与治疗后对比,存在差异,治疗后CECs水平明显下降,P0.001。对照组治疗前VCEC与治疗后对比存在差异,P0.001。治疗组治疗前CECs与治疗后对比,存在差异,P0.001。治疗组治疗前VCEC与治疗后对比,存在差异,治疗后v CEC水平明显下降,P0.001。3.对比血性组(2b+3b)与非血性组(3a+2a)治疗前CECs及v CEC差别。血性组及非血性组治疗前CECs水平符合正态分布检验,采用两样本Student's t test,P值=0.0110.05,差异有统计学意义。血性组及非血性组治疗前VCEC水平对比,P=0.0830.05,差异无统计学意义。4.治疗组RR率80%;对照组RR率78.9%,采用卡方检验比较治疗组及对照组有效率,P=0.716,无统计学差异。2a组治疗前后CECs与2b组治疗前后CECs对比,采用配对T检验,P=0.010.05,差异有统计学意义。2a组治疗前后v CEC与2b组治疗前后v CEC下降对比采用配对T检验,P值=0.0470.05,差异有统计学意义。3a组治疗前后及3b治疗前后CECs下降对比采用方差不齐配对T检验,P=0.3880.05,差异无统计学意义,两组CECs水平下降无差异。3a组治疗前后及3b组治疗前、后v CEC下降对比采用配对T检验,P=0.3030.05,差异无统计学意义。5.治疗前CECs水平与治疗效果相关性的研究采用spearman‘s相关分析,相关系数rs=-0.170,P=0.300,无统计学意义,无相关性。治疗前VCEC水平与治疗效果相关性的研究采用spearman‘s相关分析,相关系数rs=-0.471,P=0.003,有统计学意义,呈负相关。结论:1.循环内皮细胞是观察卵巢癌伴有恶性腹腔积液患者腹水控制的一个潜在的指标。2.腹腔热灌注治疗及恩度联合腹腔热灌注治疗是治疗卵巢合并腹腔积液一个有效的措施。3.恩度联合腹腔热灌注化疗有提高腹腔热灌注化疗有效率的趋势,无统计学意义。4.恩度针对血性腹腔积液效果更好,可以得到更好的控制。5.VCEC水平与卵巢癌合并腹腔积液的患者治疗效果呈负相关。
[Abstract]:Objective: the incidence of ovarian cancer in the pathogenesis of cancer in women around the world in eighth, the United States released data about 40% of patients can be cured, is female gynecological tumor associated with the highest mortality rate in our country. But most of the patients are stage III, good prognosis owe the recommended treatment is at present. Cytoreductive surgery and intraperitoneal hyperthermic perfusion chemotherapy, but the treatment of high risk. The circulating endothelial cells (CECs) and activation of circulating endothelial cells (VCEC) is a present in the peripheral blood endothelial cells, experiments have shown that with the progression of the tumor increased, with the decline of effective treatment, is a the observed index prediction of tumor and prognosis. This experiment is through the number of CECs and VCEC detection in the peripheral blood of IPHP simple ovarian perfusion chemotherapy and evaluate the effect of Endostar and correlation. Methods: using random method 39 patients were divided into two groups, 20 cases in the treatment group combined with Endostar hyperthermic intraperitoneal chemotherapy, 19 cases in the control group used simple peritoneal perfusion chemotherapy. In 1 weeks before and after treatment from peripheral blood flow cytometry was used to detect circulating endothelial cells (CECs) and activation of circulating endothelial cells (VCEC in addition to the physical examination center.) from peripheral blood of healthy women as negative control. Observe: 1) control group before treatment, the treatment group before treatment and healthy population CECs and VCEC index and difference; 2) the control group and the treatment group after the treatment of CECs and VCEC index and difference; 3) in the treatment group before and after hemorrhagic ascites and ordinary yellow green CECs and VCEC differential treatment of ascites; 4) group and treatment group curative effect of anti-tumor therapy and the difference of control. All of the statistical data and charts are used in SPSS 16 and EXCEL 2010; all data representation; all statistical analyses were two-sided analysis P0.05, which has statistical significance; the relevant measurement data with normal distribution by t test comparison, comparing the efficiency of using the chi square test, using Spearman 's correlation analysis. Results: 1. healthy before treatment group CECs and control group had significant difference (p0.001) before treatment, CECs treatment group and healthy group results there was significant difference (p0.001); the treatment group and the control group had no significant difference (p=0.658) before treatment. V healthy group CEC and control group had significant difference (p0.001), V CEC health group before treatment and the treatment group had significant difference (p0.001), there was no significant difference between the treatment group and the control group (p=0.726.2.) the control group before treatment and after treatment CECs comparison, there are differences, the level of CECs decreased significantly after treatment, P0.001. group before treatment and after treatment of the existence of differences between VCEC, P0.001. treatment group before and after treatment CECs comparison, differences in P0.001. treatment group Compared with before treatment, after the treatment with VCEC differences, V CEC levels were significantly decreased after treatment, compared with P0.001.3. group (2b+3b) and non hemorrhagic hemorrhagic group (3a+2a) and V CEC CECs before treatment difference. Hemorrhagic group and non hemorrhagic group CECs level before treatment with normal distribution test, using two sample Student's t test. P =0.0110.05, the difference was statistically significant. Blood group and non hemorrhagic group comparison, VCEC level before P=0.0830.05, there was no significant difference between.4. treatment group RR was 80%; the control group was 78.9% RR, using chi square test to compare the efficiency of the treatment group and the control group, P= 0.716, no significant difference between the groups before and after treatment before and after.2a CECs and CECs in 2B group compared with paired T test, P=0.010.05, the difference has statistical significance before and after treatment in group.2a and group 2B before and after V CEC treatment of V CEC decreased compared with paired T test, P value =0.0470.05, the difference has statistical significance before and after treatment in group.3a Before and after treatment of CECs and 3b decreased compared with the homogeneity of variance paired T test, P=0.3880.05, no significant difference between the CECs levels of the two groups decreased there was no difference between group.3a and group 3B before and after treatment before treatment, after V CEC decreased compared with paired T test, P=0.3030.05, of no significant difference between the level of CECs before and.5. treatment. Effect of treatment with Spearman 's correlation analysis, correlation coefficient rs=-0.170, P=0.300, no statistical significance, no correlation. The VCEC level before treatment and treatment effect of correlation with Spearman' s correlation analysis, correlation coefficient rs=-0.471, P=0.003, a statistically significant negative correlation. Conclusion: 1. circulating endothelial cells is observed in the ovary carcinoma with malignant ascites in patients with ascites control is a potential indicator of.2. intraperitoneal hyperthermic perfusion treatment and Endostar combined with intraperitoneal hyperthermic perfusion therapy is a treatment of ovarian complicated with ascites .3. Endostar combined with intraperitoneal hyperthermic perfusion chemotherapy is effective to improve the efficiency of peritoneal perfusion chemotherapy trend, no significant.4. for better effect of Endostar bloody peritoneal effusion, was negatively related to treatment effect can get better control the level of.5.VCEC and ovarian cancer with ascites.

【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31

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