TACE联合PMCT治疗中晚期肝癌的近期临床研究

发布时间：2018-05-02 12:21

本文选题：TACE + PMCT　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:通过对比经动脉导管灌注化疗栓塞术(TACE)联合微波消融术(PMCT)与单纯TACE处理前后血清血管内皮生长因子(VEGF)、血清甲胎蛋白(AFP)、肝癌患者肝储备功能的变化情况以及治疗后病灶控制率、并发症,探讨TACE联合PMCT治疗肝恶性肿瘤的优势;并通过比较两组患者治疗前后T淋巴细胞亚群的变化,探讨PMCT对患者机体免疫功能的影响。方法:将我科2016年1月至2017年1月符合本研究入组标准的肝癌病人共78例次,分为实验组(TACE联合PMCT组)和对照组(TACE组),其中实验组36例,对照组42例;两组患者均予以TACE以及常规护肝降酶、抗乙肝病毒等基础治疗,实验组在TACE后5~7天进行PMCT,分别在TACE术前1天、TACE或PMCT术后5天抽取外周血测量血清VEGF、AFP水平以及肝储备功能即ICG R15(吲哚菁绿试验15min滞留率)以及T淋巴细胞亚群的变化;术后观察两组病人并发症情况;术后1月复查AFP水平并行增强CT或MRI检查,评估病灶的控制率(完全缓解+部分缓解+疾病稳定)。结果:1、对照组TACE治疗后血清VEGF浓度较治疗前明显升高,差异具有统计学意义(P0.05);实验组TACE联合PMCT治疗后血清VEGF浓度较治疗前明显下降,差异具有统计学意义(P0.05)。2、对照组42例患者中30例术前AFP水平升高的患者,术后1月复查AFP均有不同程度降低,其中4例(4/30,13.3%)患者恢复正常,12例(12/30,40.0%)患者下降≥50%;实验组36例患者中25例AFP水平升高的患者,术后1月复查AFP,均有不同程度降低,其中7例(7/25,28.0%)患者恢复正常,13例(13/25,52.0%)患者下降≥50%。实验组经治疗后AFP下降率明显优于对照组,差异具有统计学意义(P0.05)。3、对照组TACE治疗后肝储备功能吲哚菁绿15分钟滞留率(ICG R15)较治疗前明显升高,差异具有统计学意义(P0.05)。实验组TACE联合PMCT治疗后肝储备功能吲哚菁绿15分钟滞留率(ICG R15)较前降低,差异具有统计学意义(P0.05)。4、对照组患者TACE治疗后CD3+T细胞、CD4+T细胞水平及CD4+/CD8+比值均明显下降,CD8+T细胞水平较治疗前升高,差异具有统计学意义(P0.05);实验组患者TACE联合PMCT治疗后CD3+T细胞、CD4+T细胞水平及CD4+/CD8+比值均下降,CD8+T细胞水平较治疗前升高,但差异无统计学意义(P0.05)。5、病灶控制率对比:根据世界卫生组织(WHO)实体瘤测量标准进行评价病灶控制率(完全缓解+部分缓解+疾病稳定),其中实验组CR 7例,PR14例,SD 12例,PD 3例,控制率为91.7%(33/36);对照组CR 4例,PR 13例,SD 14例,PD 11例,控制率为73.8%(31/42)。实验组1月病灶控制率明显高于对照组,差异有统计学意义(P0.05)。6、两组患者除有恶心、呕吐、发热、疼痛等常见并发症外,两组各出现1例严重并发症,对照组中出现1例(1/42,2.4%)胆汁瘤;实验组中出现1例(1/36,2.8%)胆道支气管瘘,两组间差异无统计学意义。结论:1、TACE治疗会损害肝脏功能,PMCT治疗对肝脏的功能影响不大;2、TACE治疗对肝癌患者的细胞免疫具有一定的损害,而PMCT可在一定程度上提高患者细胞免疫;3、TACE与PMCT治疗肝癌相互补充,二者联合具有安全、实用、有效、优势互补的特点,可提高肝癌患者的疗效,减少转移和复发,具有一定的临床推广价值。
[Abstract]:Objective: To compare the changes of serum vascular endothelial growth factor (VEGF), serum alpha fetoprotein (AFP) and liver reserve function in patients with liver cancer before and after transcatheter arterial catheter perfusion chemotherapy (TACE) combined with microwave ablation (PMCT) and simple TACE treatment, and the control rate and complications after treatment, and discuss the combination of TACE and PMCT in the treatment of liver malignancies. By comparing the changes of T lymphocyte subsets before and after treatment in two groups of patients, and to explore the effect of PMCT on the immune function of the patients. Methods: 78 cases of liver cancer patients who were in accordance with the standard of this study from January 2016 to January 2017 were divided into the experimental group (TACE combined PMCT group) and the control group (group TACE), of which 36 cases were in the experimental group, The control group had 42 cases; the two groups were treated with TACE, conventional liver protection, anti HBV and other basic treatments. The experimental group performed PMCT on 5~7 days after TACE. The serum VEGF, AFP level and ICG R15 (indocyanine green test 15min retention) and lymph fines were taken at 1 days before TACE and 5 days after TACE or PMCT respectively. Changes in the cell subgroup; after the operation, the complications were observed in two groups of patients. After the reexamination of AFP level in January and the CT or MRI examination, the control rate of the focus (complete remission + partial remission + disease stability). Results: 1, the serum VEGF concentration in the control group was significantly higher than before the treatment (P0.05); the experimental group TACE combined with TACE. The concentration of serum VEGF decreased significantly after treatment with PMCT, and the difference was statistically significant (P0.05).2. In the 42 patients in the control group, 30 cases with higher AFP level before operation were reduced in different degrees in January, of which 4 cases (4/30,13.3%) were restored to normal, 12 cases (12/30,40.0%) decreased more than 50%, and 2 of the 36 patients in the experimental group were 2. In 5 patients with elevated AFP level, AFP was reviewed in January, and 7 cases (7/25,28.0%) were restored to normal, and 13 cases (13/25,52.0%) were significantly better than the control group after treatment. The difference was statistically significant (P0.05).3, and the liver reserve function of indocyanine green 15 after TACE treatment in the control group. The rate of clock retention (ICG R15) was significantly higher than that before the treatment (P0.05). The 15 minute retention rate of indocyanine green (ICG R15) after TACE combined with PMCT in the experimental group was lower than that before, and the difference was statistically significant (P0.05).4. The CD3+T cells in the control group were treated with TACE, and the CD4+T cell level and the ratio were all clear. The level of CD8+T cell was significantly higher than that before the treatment (P0.05). The level of CD3+T cells, CD4+T cell level and CD4+/CD8+ ratio decreased after TACE combined with PMCT in the experimental group, and the level of CD8+T cells was higher than that before the treatment, but the difference was not statistically significant (P0.05).5, the control rate of the lesion was compared: according to WHO (WHO) Solid tumor measurement standard was used to evaluate the control rate of focus (complete remission + partial remission + disease stability). In the experimental group, CR 7 cases, PR14 cases, SD 12 cases, PD 3 cases, control rate 91.7% (33/36), control group CR 4 cases, PR 13 cases, SD 14 cases, PD 11 cases, and the control rate is 73.8% (31/42). In the experiment group in January, the focus control rate was obviously higher than the control group, the difference has statistics Learning significance (P0.05).6, two groups of patients, except for nausea, vomiting, fever, pain and other common complications, the two groups of 1 cases of severe complications, 1 cases in the control group (1/42,2.4%) cholangioma, 1 cases (1/36,2.8%) biliary fistula in the experimental group, the two groups have no statistically significant difference. Conclusion: 1, TACE treatment will damage liver function, PMCT treatment 2, TACE treatment has certain damage to the cell immunity of the patients with liver cancer, and PMCT can improve the cell immunity of patients to some extent; 3, TACE and PMCT are complementary to the liver cancer. The two combination is safe, practical, effective and complementary, which can improve the curative effect of liver cancer patients and reduce the metastasis and relapse. Hair has certain clinical value.

【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

【参考文献】