本文關鍵詞：惡性腹腔積液中內皮細胞的檢測及其與臨床療效相關性的初步研究　出處：《安徽醫(yī)科大學》2015年碩士論文　論文類型：學位論文

  更多相關文章： 內皮細胞 重組人血管內皮抑素 惡性腹腔積液

【摘要】：目的通過觀察腹腔內灌注重組人血管內皮抑素聯(lián)合氟尿嘧啶(5-FU)治療惡性腹腔積液的臨床療效,檢測治療前后腹腔積液中內皮細胞(Endothelial cells,EC)的變化,從而探討內皮細胞在惡性腹腔積液治療中的應用價值。方法選取2013年2月~2014年8月安徽省立醫(yī)院均有脫落細胞學診斷的晚期腫瘤惡性腹腔積液患者39例(其中胃癌21例、結直腸癌4例、胰腺癌2例、膽囊癌6例、不明原因惡性腹腔積液6例)接受重組人血管內皮抑素聯(lián)合5-FU腹腔內治療;所有患者此治療方案前2個月內未行任何抗腫瘤治療。39例惡性腹腔積液患者均在充分放液后采用腹腔內注入重組人血管內皮抑素60mg聯(lián)合氟尿嘧啶(5-FU)1.0g治療,治療結束后囑患者30min內頻繁改變體位,盡可能使藥物與腹腔各個部位充分接觸,每周重復為一周期。完成2個周期后觀察惡性腹腔積液治療療效、生活質量(QOL)和不良反應;治療前(基線水平)、治療2個周期后(第3周期治療前)通過流式細胞學進行腹腔積液內皮細胞的測定。治療療效參照WHO腹腔積液評價標準,生活質量(QOL)參照Karnofsky評分標準,不良反應按照美國國家癌癥研究所通用藥物毒性反應標準(NCI-CTC4.0版)。結果(1)所有患者接受2個周期重組人血管內皮抑素聯(lián)合氟尿嘧啶腹腔內治療后進行評估,39例患者中,完全緩解(CR)1例,部分緩解(PR)16例,穩(wěn)定(SD)14例,進展(PD)8例�？陀^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穩(wěn)定(28.2%),7例(17.9%)QOL下降;(3)39例患者出現(xiàn)3~4級的毒性有10例,包括白細胞下降5.1%(2/39)、血小板下降2.6%(1/39)、貧血5.1%(2/39)、惡心10.3%(4/39)以及腹瀉2.6%(1/39),未見其它嚴重不良反應;(4)惡性腹腔積液內皮細胞臨床有效者EC治療前(0.22±0.06)%,治療后(0.12±0.08)%,生活質量改善者治療前(0.19±0.08)%,治療后(0.13±0.08)%,臨床有效者(PR)經治療后EC下降明顯(P=0.005),有統(tǒng)計學意義,臨床無效者(SD+PD)治療前后無統(tǒng)計學差異(P=0.114),生活質量改善者經治療后EC下降明顯(P=0.032),有統(tǒng)計學意義,生活質量無改善者治療前后無統(tǒng)計學差異(P=0.359)。結論腹腔內應用重組人血管內皮抑素聯(lián)合氟尿嘧啶治療惡性腹腔積液有較好的近期療效,并能改善生活質量,不良反應輕,安全,可行。腹腔積液中內皮細胞(EC)百分比在治療前后有一定變化,其變化程度對預測療效有一定的指導意義,值得臨床進一步探討研究。
[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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