恩度联合TACE不同用药方案对原发性肝癌血清VEGF表达对比分析

发布时间：2018-05-27 23:40

本文选题：原发性肝癌 + 化疗栓塞　；参考：《青岛大学》2015年硕士论文

【摘要】：目的:探讨恩度联合TACE不同用药方案对中晚期原发性肝癌血清VEGF表达对比分析。方法:选择均有肝脏病理穿刺结果证实或符合原发性肝癌的临床诊断标准的60例中晚期肝癌患者,60名患者随机分为二组,A组,对照组,30例(恩度联合TACE动脉灌注栓塞组);B组,实验组,30例(恩度联合TACE动脉灌注栓塞并术后静脉滴注组)。A组(对照组):术中首先将导管选择至肿瘤病灶的供血靶动脉行灌注治疗,缓慢手推注射器灌注恩度15mg、奥沙利铂50mg及注射用盐酸表柔比星30mg,再将恩度15mg与5~15ml超液态碘化油(用量据病灶大小而定)通过T型三通旋转阀门充分乳化,后在透视下缓慢栓塞肿瘤病灶及供血靶血管。B组(实验组):手术方式及化疗栓塞药物选择同A组,不同在于术后第一天开始静脉滴注恩度,连续滴注7天,用法:将30mg恩度加入500ml0.9%Na Cl中缓慢静脉滴注。全组60例患者分别于术前1天,术后3天、7天、15天、30天各抽取空腹静脉血3ml,通过酶联免疫吸附实验法检测60例患者血清中血管内皮生长因子(VEGF)的表达水准并统计分析,随访记录观察术后并发症。结果:1.ELISA法检测结果示:A、B两组患者术前1天血清中VEGF表达水准相比较差异不明显(P0.05)。A、B两组患者术后第三天血清中VEGF水平都升高并达最高值,术后7天、15天、30天血清中VEGF表达水准表现为持续缓慢减低且均低于术前水准,术后A、B两组各个时段血清中VEGF表达水准与术前相比较差异显著(P0.05)。方差分析结果示:A、B两组术后各时段血清中VEGF表达水准相比较差异显著(P0.05)且实验组VEGF表达水准明显低于对照组。2.恩度并发症:A、B组均出现一过性转氨酶升高,轻度黄疸,恶心呕吐等TACE术后综合征,A、B组各有3例患者出现胸闷不适,但均无心电图改变,两组患者均未发现鼻出血、心律失常等不良反应。两组患者中恩度相关并发症的发生比较无显著差异(P0.05)。结论:1.恩度联合TACE治疗原发性肝癌能够显著降低血清中VEGF表达水准。2.恩度联合TACE并术后静脉滴注用药方式较单纯恩度联合TACE动脉灌注栓塞为优。
[Abstract]:Objective: to investigate the expression of serum VEGF in patients with advanced hepatocellular carcinoma (HCC) treated with Endol combined with TACE. Methods: sixty patients with advanced liver cancer were randomly divided into two groups: group A (n = 30) and group B (n = 30). Experimental group (n = 30) (Endol combined with TACE artery infusion embolization and intravenous infusion after operation). Group A (control group): the catheter was first selected to the target artery of the tumor focus during the operation for perfusion therapy. Slow hand push injector infused Endol 15mg, oxaliplatin 50mg and epirubicin hydrochloride 30mg for injection, then emulsified Endor 15mg and 5~15ml super-liquid iodized oil (depending on the size of the lesion) through T-type three-way rotary valve. Then the tumor focus and blood supply target vessels were slowly embolized under fluoroscopy. Group B (experimental group: operation method and chemoembolization drug selection was the same as group A, the difference was that the first day after operation, intravenous infusion of Endol, 7 consecutive days), Usage: add 30mg Endol to 500ml0.9%Na Cl by slow intravenous drip. Fasting venous blood samples were collected from 60 patients 1 day before operation, 3 days after operation and 15 days to 30 days after operation. The expression level of vascular endothelial growth factor (VEGF) in serum of 60 patients was detected by enzyme linked immunosorbent assay (Elisa) and analyzed statistically. Postoperative complications were observed by follow-up records. Results 1. The results of Elisa showed that there was no significant difference in the level of VEGF expression between the two groups on the first day before operation. The serum VEGF level of the two groups increased to the highest level on the third day after operation. The expression level of VEGF in serum from 7 days to 15 days to 30 days after operation was decreased slowly and was lower than that before operation. The level of VEGF expression in serum of group A and B was significantly different from that before operation (P 0.05). The results of ANOVA showed that the level of VEGF expression was significantly lower in the two groups than that in the control group (P 0.05) and the level of VEGF expression in the experimental group was significantly lower than that in the control group (P 0.05). There were 3 cases of chest tightness in each group with mild jaundice, nausea and vomiting, but no changes in electrocardiogram. No epistaxis was found in both groups. Adverse reactions such as arrhythmia. There was no significant difference in the incidence of Endodendron related complications between the two groups (P 0.05). Conclusion 1. Endol combined with TACE in the treatment of primary liver cancer can significantly reduce the level of VEGF expression in serum. 2. 2. Endor combined with TACE and intravenous infusion after operation was better than simple Endol combined with TACE arterial infusion embolization.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.7

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