發(fā)布時(shí)間：2018-06-18 21:23

  本文選題：原發(fā)性肝癌 + 超選擇性肝腫瘤動(dòng)脈化療栓塞術(shù)��； 參考：《延邊大學(xué)》2017年碩士論文

【摘要】：目的探討S-TACE聯(lián)合阿帕替尼治療原發(fā)性肝癌患者血清和肝癌組織中血管生成因子的表達(dá)及其臨床意義。方法收集我院2015年1月至2015年6月收治的原發(fā)性肝癌患者46例,分為單純S-TACE組(A組,n=23)和S-TACE聯(lián)合阿帕替尼組(B組,n=23)。檢測(cè)所有患者治療前、后血清VEGF、HIF-1α濃度及肝功能。部分患者(20例)經(jīng)B超引導(dǎo)下穿刺活檢獲取肝腫瘤標(biāo)本,采用免疫組化染色法檢測(cè)術(shù)前及術(shù)后第4周腫瘤組織中VEGFR-2表達(dá)及MVD。根據(jù)46例患者術(shù)前及術(shù)后第4周肝臟CT增強(qiáng)掃描的肝內(nèi)病灶變化,比較兩組DCR及OR。觀察與S-TACE及口服阿帕替尼相關(guān)不良反應(yīng)的發(fā)生情況,隨訪3個(gè)月-2年,分析疾病進(jìn)展情況。結(jié)果1.A、B兩組術(shù)后第1周肝功能AST、ALT、TBIL及DBIL均較術(shù)前升高,具有統(tǒng)計(jì)學(xué)差異(P0.05),治療后A、B組間比較不具有統(tǒng)計(jì)學(xué)差異。2.A組術(shù)后第1周、第4周血清VEGF、HIF-1α濃度與術(shù)前比較表現(xiàn)為先上升后下降;B組術(shù)后第1周、第4周血清VEGF、HIF-1α與術(shù)前比較呈持續(xù)下降,具有統(tǒng)計(jì)學(xué)差異(P0.05)。治療后第4周組間比較;B組下降更明顯,具有統(tǒng)計(jì)學(xué)差異(P0.05)。3.A、B兩組術(shù)后第4周肝癌組織中VEGFR-2陽(yáng)性表達(dá)率及MVD均低于術(shù)前,且B組下降更明顯,具有統(tǒng)計(jì)學(xué)差異(P0.05)。4.A、B兩組術(shù)后腫瘤直徑均較術(shù)前縮小,治療后A、B組間比較B組腫瘤縮小更顯著,具有統(tǒng)計(jì)學(xué)差異(P0.05)。5.B組術(shù)后 4 周DCR為 95.65%、OR為 60.87%,A組DCR為 82.61%、OR為34.78%,B組雖然高于A組,但不具有統(tǒng)計(jì)學(xué)差異(P0.05)。6.B組的TTP為 11.72±4.94 月,A組TTP為 8.15±4.74 月,B組TTP長(zhǎng)于A組,具有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1.S-TACE聯(lián)合阿帕替尼治療肝癌療效優(yōu)于單純S-TACE,其機(jī)制與抑制腫瘤的血管生成有關(guān)。2.S-TACE聯(lián)合阿帕替尼可延長(zhǎng)患者TTP,改善預(yù)后,提高生存。
[Abstract]:Objective to investigate the expression and clinical significance of angiogenic factor in serum and liver cancer tissues of patients with primary liver cancer treated with S-TACE combined with apatinib. Methods from January 2015 to June 2015, 46 patients with primary liver cancer were divided into two groups: S-TACE group (group A) and S-TACE group (group B) combined with Apatinib group (group B). The serum level of VEGF HIF-1 偽 and liver function were measured before and after treatment. Liver tumor specimens were obtained by B-ultrasound guided biopsy. The expression of VEGFR-2 and MVD were detected by immunohistochemical staining before and 4 weeks after operation. According to the changes of hepatic lesions in 46 patients before and 4 weeks after operation, DCR and ORs were compared between the two groups. The adverse reactions associated with S-TACE and oral apatinib were observed and followed up for 3 months to 2 years to analyze the progress of the disease. Results 1. The liver function of group A B was significantly higher than that of group A (P 0.05) at the 1st week after operation. There was no significant difference between group A and group A in the first week after operation. 2. There was no significant difference between group A and group A at the first week after operation, and there was no significant difference between group A and group A in the first week after operation (P < 0.05). At the 4th week, the serum level of VEGFU HIF-1 偽 increased at first and then decreased at the first week after operation. At the 4th week, the serum level of VEGFU HIF-1 偽 decreased continuously compared with that before operation, and there was a statistical difference between the two groups (P 0.05). The expression of VEGFR-2 and MVD in liver cancer tissues in group B were significantly lower than those in group B at the 4th week after treatment, and the decrease was more significant in group B than that in group B at the 4th week after treatment, and there was statistical difference between group B and group B (P 0.05. 3.) the positive expression rate of VEGFR-2 and MVD were significantly lower in group B than before operation. After treatment, the diameter of tumor in group A was significantly smaller than that in group B, and the DCR of group A was 95.65% (OR = 60.87) 4 weeks after treatment, although the DCR of group B was higher than that of group A (34.78%, P < 0.05), and that of group A was significantly lower than that of group B (P < 0.05), and that of group A was significantly higher than that of group B (P < 0.05), and that of group A was significantly higher than that of group B (P < 0.05), and that of group A was significantly higher than that of group B (P < 0.05). However, the TTP of group A was 8.15 鹵4.74 months longer than that of group A, and the TTP of group B was longer than that of group A (11.72 鹵4.94 months, P < 0.05). Conclusion 1. The therapeutic effect of S-TACE combined with apatinib on liver cancer is better than that of S-TACE.The mechanism of S-TACE combined with Apatinib is related to the inhibition of tumor angiogenesis. 2. S-TACE combined with apatitinine can prolong TTP, improve prognosis and improve survival. 2.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 魯丁瑜;李娜;李志平;;多靶點(diǎn)抗腫瘤新藥阿帕替尼的研究進(jìn)展[J];華西藥學(xué)雜志;2017年01期

2 樊斌;張家耀;張勇;李錦貌;李偉;;原發(fā)性肝細(xì)胞癌患者血清TATIP2/TIP30、RBBP4水平與臨床病理的關(guān)系[J];檢驗(yàn)醫(yī)學(xué)與臨床;2016年23期

3 吳會(huì)玲;宋希;;乙型肝炎病毒感染與肝癌相關(guān)性多因素研究[J];現(xiàn)代醫(yī)藥衛(wèi)生;2016年22期

4 黎曉武;李金強(qiáng);羅向波;侯琴;何珊;;血清GP73、HSP27聯(lián)合AFP檢測(cè)在HBV相關(guān)早期肝細(xì)胞癌診斷的價(jià)值[J];實(shí)用預(yù)防醫(yī)學(xué);2016年11期

5 何澤玲;曹建彪;范公忍;;熱休克蛋白70在肝細(xì)胞癌中的表達(dá)及作用[J];臨床肝膽病雜志;2016年11期

6 厲英超;米琛;薛揮;李偉之;李培杰;呂良山;;介入化療栓塞治療對(duì)原發(fā)性肝癌患者細(xì)胞免疫功能的影響[J];重慶醫(yī)學(xué);2016年31期

7 劉小龍;;液體活檢在肝癌早期診斷與預(yù)后判斷中的臨床價(jià)值[J];瀘州醫(yī)學(xué)院學(xué)報(bào);2016年05期

8 王鐵征;臧運(yùn)金;林棟棟;趙元順;李寧;;甲胎蛋白及α-L-巖藻糖苷酶在乙肝相關(guān)肝癌診斷中的作用[J];中國(guó)醫(yī)刊;2016年11期

9 張寧剛;王育生;;甲磺酸阿帕替尼片治療原發(fā)性肝癌肺轉(zhuǎn)移1例報(bào)道[J];腫瘤防治研究;2016年10期

10 黃述婧;姜菲菲;王穎;于艷華;婁金麗;;AFP與PIVKA-Ⅱ聯(lián)合檢測(cè)在原發(fā)性肝癌診斷中的應(yīng)用研究[J];標(biāo)記免疫分析與臨床;2016年10期

相關(guān)博士學(xué)位論文 前2條

1 范莎莎;新的血清標(biāo)志物HTATIP2/TIP30在肝癌診斷中的研究[D];南方醫(yī)科大學(xué);2014年

2 林巖;欖香烯注射液聯(lián)合甲磺酸阿帕替尼抗肝癌的實(shí)驗(yàn)研究[D];南京中醫(yī)藥大學(xué);2014年

相關(guān)碩士學(xué)位論文 前2條

1 王欣;索拉菲尼聯(lián)合TACE治療晚期肝細(xì)胞肝癌的薈萃分析[D];重慶醫(yī)科大學(xué);2016年

2 滕凱;恩度聯(lián)合肝動(dòng)脈化療栓塞后肝癌患者血清VEGF、HIF-1A、OPN、CTGF的動(dòng)態(tài)變化[D];山東大學(xué);2013年

，

本文編號(hào)：2036910